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WOUIN CO�R 511k J EHYIROMM L HEALTH UAYISH HERVICES P O,BOX 388,304 FAST VVI__A AVENUE,STOCKTON,CA 9SMI-M \ 1209)481,3420 f ?T-1+N0NREFURnA6LF PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICOMP111t In TFQlieml ,''PLICATION IB HEREBY MADE T THE BAN JOAOUIH COUNTY FOR A PERMIT TO CONSTRUCt AND/OR INSTALL TNT WORN DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE VATH BAN F 1AGUIN COUNTY DEVELOPME 7rTLE, HAPTER 9-1110.1' THE STANDAR B OF BA JaAaVIN COVNTY PVBUC HEALTH SERVICES, ,�ENVIRONMENTAL HEALTH DIVISION. - S AOORFSs/O ! , CITY_ � W LOT 81ZE YNEfl'B NAME•/� y/y,I�S�J V��v � ADORE9B y O J7 INTRACTOR- /v A� /V 7 L T��-- ADDRE88 L UCI-W40-2-'t C^- PLO IB CONT RACTOR ADDNESS U[I PHONE k Ica OF iEP11C WORKS MEW iN4T}LLLTION REPMRrAbuITION❑ DEiTBUCTIOM❑O SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IE AY URBLE WITHIN 200 FEET OF RVILDINV.1 KRC 1-11-111HOW MANY F71 ApPSalO� I TALLAUUK MILL STAVE; RESIpErM OMMfACFAL❑ HER❑ A'46Di OF LMNO Up:.: NUMBER DF a ROOM": 1 MUMBNt OF FMKOYEEB: N�}VlBTJ�fA OF SOIL TO A DEPTH OF 3 FEET{I PTlgVMP SO CHARACT d �/_ WATER/TABLE pEPH �V YRG.TANILlORUFE TRFA-p, ❑TYPEIMFO CAPACITY �(p FJO �,q'/[�.-��'/. NO,COMPARTMEMBT��._ .0 TTREA rm ENT PLANT LJ DISTANCE TO NEAREST- WELLSY�2 FOVNOATION/� ' PpOpERYY LINEi�� LIFT STATION❑r�-G�2E� TYPE OF/ump SAND OIL SEPARATOR IENCLOGEO BYGIEW ACTINO UNE / •i LENGTH....ES_T;L-UO I I,4/L.J.�_ DISTANCE TO NEAREST:WELL_FOUNDATION•JL� F FI4oPERiI'LO9E�_,_,��x ' 7FA SED /❑-WROTH LEWTH DEPT" DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE OVNOED ❑"OTH�7 LENGTH DEPTH DSTANCE TO NEAREST:WELL FOUHDATIOH PROPERTY UNE JPAOE PITS �II----,,OEPTlI- S f SIZE S'�c3�! NUMBER DISTANCE TO NEAREST:WELLS a FOUNOA7HINI6G7 P ;,ERTY UNE AL1 - MAPS LJ WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE F."Pos"N" ❑MM14 LENOTH DEPTH DISTANCE to NEAREST:WELL FOUNDATION PROPERTY UNE BEREAV CERTIFY THAT 1 HAVE PREPARED THIS APPLN=ATION AHD THAT T WORK WILL BE DONE IN ACCORDANCE WE1H BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AHD RILES - YDNEO OF THESANJOAUUINCOUtM.HOME OWNERORUCEN9 AOENT'B SlaNATURECEFRIFIEB THE FOLI.OWMI4 CERTIFYTNAT IN THE PERFORMANCE OF THE WOPK FORWHION US IS Ig6 .1 SHALL NOT EMPLOY RSON IN DUCH AMA AS TO BECOME SUBJECT TO WORKMAN '8 COMPENSATION UlR/S OF CAEIFDRNIq,°CONTRACTOR'S HIISNO OR J ONTRACiINtl BI A RE CE 8 F. Ot'I CERTIFY T T 1 THE PERFORMANCE OF THE WORK FOR WHICH TH18 PEAM}T IS ISSUED,I SHALL EMPLOY PERSONS SURIECT 70 D MAN'S COMPLNS T SOF IFOANIA.' LL 24 HOURS IN ADVANCE FOR ALL REGLIRED INSPECTIONS,COMPLETE DRAWPO BELOW. ONfD TITLE: DATE: PLOT PUN IDRAW TO SCALER SCALE •eo NAMES OF STREETS OR ROADS NEARER TO OR BOUNDING THE PROPERTY, 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. - EXPANSION OF SFWAaE DISPOSAL BYBTEMS. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED STRUCTURES S.LOCATION OF WELLS WITRIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AB PATIOS,ORIVEWAYB.AND WALIO. THE PROPERTY OR ADJOINING PROPERTY. r .... -.y.... .. :..... ... ...y.-....- v. -.... - 1 p t/�, . .......... ...... ..: ;L ' - 'r . . r --- ......... ................ .. j .... ......... L Fj ........... ........ F1 �z°�fs ... `., ..,.., X. . ... .....' NOV 12.` 1998 -a ... ...... ;......... ................... 1 :... . ....... !.. G 7 13 fh!:ih -......... lJ✓ wC�,. -. :-.. .... .... ............. .. .. ...r... ...... .- _ .... _ \ UU, FOR bVMTMENT USE ONLY F�IATION ACCEFTED BY Ir DATE: T AREA: I R O�LR_BE�Nl�MP INSKCTIOII BYPJJ— GATE[ 1/7`T FINAL LHSPECTION BY DATE .DDITWNAL CgMMENTS: r 1 ACCOIINTIMO ONLY: MOI FAC! _ EE FELINN AMOUNT RIM I ITO CIECN 1CASH RECOVER BY DATE SR I PCRMITNL 131 INVOICE _ f 1h .nU If Pub,Health So"..Enviro.174(3/96)