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'"new SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES -�6;7Z Q / .2— ENVIRONMENTAL ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201.388 (2091489-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED lCompl$te in Triplicate) APPLICATION IB HEREBY MADE TO THE BAN JOAQUIN COVNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL TIRE WORK DESCRIBED. THIS APPLICATION IB MADE IN COMPLIANCE WITH BAN JOAWIN COUNTY DEVELOPMEW/TQJ L//E.CHJA"ER(O-1/1110.1 AND THE STANDAR/��?OF SAN JOAOUIN COUNTY AIBUC HEALTH SERVICER,ENVIRONMENEAL HEALTH DIVISION. 3/1 JOB ADORE68lOfl APA/ / W / 7•JF/�.�•(/f�(/f fj/� CITU �� LOT SIZE " RiG/ OWNER'S NAME �Q///1 iT.7 QAj p-DRE-- >n------ PHONE // // CONTRACTOR `/1J�ii./�e �/ (//'•J� ADDRESS )/ �f?AL IJCI�l/�S!J<S' R10NPFO! ' %V.?I,/ SUB CONTRACTOR ADDRESS VT� LICI PHONE TYPE OF 813PTIC WORK: MEW INSTALUTION REPAIR/AOMHON ❑ OFSTRUCTION ❑ INO SEPTIC SYSTEM PERMITTED IF MRUC SEWER IS AVAILABLE WITHIN 200 FEET OF RUILDING,I PERC TESTIsI I 1 NOW MANY A,0-0an/- INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 11OTHER 11H1JMBER OF IIVINO VMI$:/ NRIMeD1 OF SFD OMS: _ NUMBER OF EMROYFFa: CHARACTER OF SOIL TO A DEPTH OFFT..-31�FEET' / PIT./.SIIIMP BOIL CHARACTER: WATER TABLE DEPTH 5,,- EEPTICTANK/GREASETRAP W'iYPF/MFO CAPACITY 4267 C, NO.COMPARTMENTS r MO TREATMENT RANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE STATION ❑J SIZE 6 LENOTN OF LINES F PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) LFACMNO UNE yU/ DISTANCE TO NEAREST:WELL FOUNDATIONPE J�PRORTY UNE FILTER BED ❑MUTH LENGTH DEPTH DISTANCE TO NEAREST:WEIl FOUNDATION P IORRTY LINE MOUNDED 0WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION RKIRRTY UNE EYES TS R .EFTA .76 SIZE 3G NUMBE0. 7 DISTANCE TO NEAREST:WELL Som FOUNDATION 60 MKIMPTY LINF� BUMP$ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DI$POBAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINF 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOW W111 BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE"WS,AND RULES AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AOEW-8 SIGNATURE CERTIFIES THE FOLLUWINU:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WOIEL FOR WHICH THIS PERMIT 18 ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WOWMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPEN OI ��I�W1S OF OAUFO Nuk.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL�REQUIR�ED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED X ✓/'✓ iL= ,i'/(, TITLE: JjkL W14— DATE: PLOT PLAN(DRAW TO SCARF)SCALE •to 1. NAMES OF STREETS OR ROADS NEAREST TO ON BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRUWBED 2. OUTLINE OF THE PFIOMRTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DIBPOBAL SYSTEMS. J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROW SED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDINO COVERED AREAS SUCH 'AAS!PATIOS.DRIVEWAYS.AND WAIXB. THE FFK)PERTY OR ADJOINING PROPERTY. O 53iata yrs ' ajlJ G wr NQo m2 "> 1 a- - -- - ---- 1. Nov 4 1998 J '� F R DEPARTMENT USE ONLY APRJCATION ACCEPTED BY V u.aJ l DATE: 1 EA: TANK,IIT OR SUMP INSPECTION BY DATE / / FINAL 1 SPECTION BY ATE �U ADDITIONAL COMM NTS: ACCOUNTING ONLY: / FACS R CODE FEEINFO AMOUNTRIANITED CHEC /CASH RECEIVED BY DATE / SR/PERMIT NUMBER INVOICE/ A v Pub.Health So".-Enviro.174(3/96)