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APPLICATION FOR LIVID Y"'SE PERMIT <br /> ;HEALTH <br /> k; SAN JOANPUL— <br /> VIIN COUNTY RO MENTAL HEALTH DMS40NRVICES <br /> �e 1� 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NU EFUNDABEE PERMIT EXPIRES 1 YEAR FROM DATE ISSUE! <br /> IE:BgpNE/In Tr[pUnhl <br /> APPLICATION 18 HERESY MARE i0 THE BAN JOAQUIN COUNTY <br /> FOR A PERMIT To CONSTRUCT ANDY"INSTALLTHE W DW DESCRIBED.THIS APPUCATIDN IS MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER$-1110.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES'ENVIRONMp4TAL HEALTH bMsgN. /�Iy/'/ � <br /> LOT BREI"' <br /> JOB ADDREBSfORJtQ 'APNI 7 L <br /> _ �� ADDRESS 6/�T`Lr- —y~ RIONE�� <br /> OWNER'S NAMLu <br /> 11CP PHONE <br /> ADORES/ <br /> CONTRACTOR _ �•� _ — l ZG�PHONE �3 <br /> 47, <br /> SUB CRNTRACTOR L Il <br /> NEW INSTALLATION❑ IIEPANUADDIHON❑ OEATRVCTiON <br /> TYPE OF/EPfIC WORK: PEIC TE/Tld 1 MOW MANY <br /> No SEPTIC SYSTEM PEMarTEO IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.] APP1Mtlon P <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL❑ OTHER <br /> NUMBER OF WING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYER: <br /> CHARACTER OF EOR.TO A DEPTH OF 9 FEET'—�pRBUMP SOIL CNAl1AC'TER:,�� <br /> WATER TABLE DEPTH <br /> OaE_6 ivLf �'eL CAPACITY © NO.COMPAIRAIENfB <br /> SEPTIC TANKAN EASE TRAP ❑N°` <br /> r PKO TREATMENT PLANT❑ DISTANCE To NEAREST: WELL � r FOUNDATION Z�_ �rE��� <br /> LIFT STATION❑ SITE TYPE OF PUMP SAND OR SEPARATOR]ENCLOSED SYSTEL.0 <br /> DISTANCE TO NEAREST:WELL FOUNDATION PROPENrY LINE <br /> LEACHING UNE ❑ NO.S LENGTH OF LINES PROPERTY UNE <br /> ❑WIDTH LENGTH DEPTH DISTANCE TO MEREST:WELL T-0UNDATION <br /> fl PROPENTY UNE <br /> ❑WIDTH LENGTH DEPTH dsTANCE TO NEAIMST:WELL FOUNDATION <br /> MOUII➢EO p110pENrY UNE <br /> SEEPAGE PTT/ ❑DEPTH <br /> SIZE NUMBER DISTANCE TO NEARESTS WELL FOUNDATION <br /> ❑WpDTN DEPTH OrsTANCE TO NEAREST:WELL IAUNDATgN PLIOPERTY UNE <br /> SISNiK LENGTH <br /> q/PoW TONDO Q Wg7H LENDTH <br /> DEPTH DISTANCE TO NEAREST:WRL FOUNDATION pHOPERTY UNE <br /> 1 HEREBY CERTIFY THAT I HAVE pREFARED THIS APpLICAT101L AND THAT THE WORK WSJ.Be DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES ^' <br /> AND REGULATIONS OF THE BAN JGAOUIN CO .HOMEOWNER ORUCENBEO AOENTY SIONA7VRE CERTFFIESTHE FOl1AYMCo}AAEN8A7gN1AWS OF CIIUIOIWIA'C COFNTRACTOR'S HONG THEWORK OF <br /> TMs PERMIT IB I8 ALL NOT EMR PERSON N SUCH A MANNER A8 TO BECOME SUBJECT TO V VDWJAAN'B Q <br /> BION CERTIFIEBT FOLLOWNO:'1 CERTIFY THAT N THE pENFOpMAHCE OF THE WORK FOR WHICH THR PEFLArr M MBUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> 06 <br /> RC OM 8A <br /> We AU A.' THE APR1C T MUST ALL 24 HOURS IN ADVANCE FOR a,:�INSFECTpN/.GOMPIETE DRAWING BEI.oYJ. _ <br /> Y �• _ _DATE: <br /> NED x ' <br /> 'ro <br /> ROT PLAN(DRAW TO SCALER aCALE�, _ r-+ <br /> '•••�6 4.LOCATION OF HOUSE SEWAGE DISPOSAL lYHfEM OR PROPOSED <br /> BT B NEAREST TO OR BOUNDMO THE PROPENTY. - EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> THE pROpENTY.VNTH DIMENSIONS AND NORTH DIRECTION. ONE FIFTY FT.O <br /> • 1. ` W E LOCATION OF WELLS WITHIN RADNS OF O IODiORED <br /> OURNEs AND LOCATION of ALL EXISTING HIED PROPOSED S7RUCTUREB <br /> S•WFEH�O FRED AREAS SUCH AS PATIOS DWVEWAYB AND WALKS s' P'�THE Rry <br /> PROPERTY OR AbJO <br /> .... ... . . . vc�ra... Elarrr <br /> 77 <br /> QrJ�"^f.p <br /> 1 <br /> VA <br /> ...... <br /> . . <br /> ........... . . <br /> . FOR DEPARTMENT USB ONLY -,. <br /> i <br /> _ DATE: AR[At _ <br /> APPLICATION ACCEPTED BY I <br /> I DATE ! 1 _FINAL DISPECTION BY _ PATE 1 Z5 <br /> TANK,PIT OR BUMP NSPECTION BY - <br /> ADDITIONAL ceMMEHrs:_„ - �,G +.•�.1,.. <br /> Cou ILS It N <br /> •FAC! -�CJ•�I,�fNIWS 11S'-!o1} <br /> . ACCOUN"M aNLY: AI06 �.- - <br /> PBCGOE FEE INTO AMOUNT It"ITED AASH RECEVED BY DATE ON r PERMIT"LAYMEN <br /> ^ INVOM./ <br /> - Pub:Hoeft SBrv..EnvlrO.174(3185) - <br /> Ifi n <br />