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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION RO.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 9S201-3M 12091 4693420 NON•REFUNOARIE PERAHT-EXPIRES I YEAA FAOM DAT SSUED (GmPIEt[in TdPoesial APPLICATION IS HENLRY MADE TO THE SAN JOAOVIN COUNTY FOR A PERMIT 70 CONSTRVCT AND!OR INSTALL ME NORX DESCRIBED.THIS APPUCATWFE A MADE IN COMJPLIANPCE WTTH SAN JOAOUIN COUNTY OFVMOPMENT TITLE.CHAPTER 0-1110.3 AND THE STANDABOS OF/SAN JOAMIN COUNTY"LIC 14MTH SERVICES,ENVH DfNANTAL HEALTH DIVISION. JOS AODRld9?OR APN/ /6 �o I (Gr�'2a x C,Lf i/z. /�_'Cry- te L LOT _` BIi4 OWNER'S NAME5 , zz ADDRESS 's,40 Ll /-11 PHONE_ CONTRACTOR1 L, --L/_L %' ADDRESS WBCOMRACTOR ADOWSS UC■ PT10NE TYPE OF DTIC WORK: NEIN INSTALLATION❑ REPAIRIMOITIV Nfir DESTRUCTION❑ IND SEPTIC SYS7[M PERFAITTED IF PUBLIC SEWER IS AVAILABLE WIIHIN 200 FfFT GT BUILD1Nn.1 FRAC TESTDI L I NOW AOANY ApplleA4pp P N$TALLATICH WILL$FIVE•. RESIDENCEIg COMMERCIAL0THE"Q _ NUN661 OF LIVINO VNTS:� EDROOM N...OF BS: ll--Z;EMPLOYTES: CHARACTER OF FOIL TO A DEPTH OF T FEETAP&3F��d,M RAMP SOLI GIRARAC IFR: WATER TABLE DEPTH SEPTIC TANKATREASE TRAP ❑TYMMFO CAPACITY NO,COMPARTMEMS FRO/IEATMdY PLANT 13 DISTANCE TO REMEST: WELL FOIINTIAYION PROPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP RAND ON.SFPAjUy�ILIE��Lf1SED SYSTEMI F/r �• `i LFAC14NO UNE NO.S LENGTH OT UNCB //rl)�� Dle�(IJJANCrrE''TO P/N}}EAREST:VYELL��TFOVNOATIOIJZ�� PROPERTY LINE `--ID/ FITm BED ❑WO7M LENGTH_ DEPTH DISTANCE TO NEAREST:W41 FOUNDATION PROPERTY UNE �,•� MDUNDED ❑WIDTH LENGTH__DEPTH DISI ANCE TO NEAREST:WELL FOUND.TION PIIOPERTY UNE C� SEEPAGE RTS ❑DFPTH SIZE _NUMBER D/Sl AWE TO NFARFST;WELL FON:DATION POPEITY LINE 1 SUMPS ❑IMDTH LENOTH _DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SAL DISPOPONDS ❑VADTH LENDTN DEPTH �OISTANCL TO NFANEST:WELLMUNOATION PRDPERTY LINE - I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THXt THE WORK WILL BE DONE IN ACCORDANCE LNIIH SNI IOAOVN COLPIT YORDINANCES AND STATE LAWNS.AND RULES ANOIEOULATIONS OF THE SAN JOAQMCOUNTY.HOME OWNER OR LICCNNFO AGENT'S RIONATLINE CFFITIFIES THE FOLLOVANO:-I CERTWYTHAT N THE PIDFORMANCE OF THE WORK FORWHICH y� THIS PERMIT IB ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER A%TO BECOME SUBJECT TO WOMMAKS COMANSATION LAWS OF CAUWRNIA.' COIPTRACTOWS HSINO OR SUS,CONTRACTIINO SIGNATURE CERTIFIES THE MIIOWNNO:I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOO W FOCH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONA SUBJECT TO WPORLMAN'E COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOME IN ADVANCE FOR ALL REDUPIED INSFECTIONS. COMPLM DRAMNO BELOW. J SRDNED% VST �L'�LT+`�Z� TITLE:`�T37.L ry GATE: � -� PLOT PLAN MRAW TO SCALE SCALE Ip r A..NAMES OF STREETS OR PO AOS HEAPEST TO OR SOUNDING THE PPOPERTY. A.LOCATION OF MOUSE SEWAGE OISPOBAL SYSTEM OR PROPOSED 2.OUTLINE OF TILE PROPERTY.VMH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF NEWAOF DPSPOM SYSTFUN, J.ONAENMONED OUTLNES AND IOCATION OF Ali E%t$TINO AND PROPOSED STRUCTUREt, S.LOCATION OF WELD WrtTHN RADIUS OF ONE HUNDRED FIFTY FT.ON NCLUDINO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALK$. THE PiOFFFON OR ADJOININO PROPERTY. r 117, r �. .. .. no o s. PAYIwEly 9C�I �D o _ L,-It / 1� . AUG 12 11997 'YSArw �.. ,.. ENVIpPU AJOEA�LOIN(-y... . .. NMFI.[rglHF�L�IESfONI FDR DEPARTMFMI U$!ONLY /O AT9LICATION ACC EPPFD RV�\ V DATE: S'I L �� AREA-� TANK,PT OR SUMP INBPECT!O!I BY D 0.TE .r' f _,FAINAL 1NBPFGTION SY i L L 1��L�A'.(^1 OAA'E- I-rhI 1) AMIKINAL COMMENTS: IJ E P'/1'Y nnAA{'� likasez DI+�4 td� ,�F/,I✓�� g1 l E/ MCOVNiNO ONLY; AI0I FA(:J K LOO[ FLE INTO AM ONNT REM.T[D �/KASH RECOVER NY DATE mIPERNNTN 1pvm C, 10 IIS 1$d-ted 433AR8 2 v`408f3 Pub.Health SON.-EnvlrO.174(3196)