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ICATION FOR UQUIO WASTE PERMIT SAtTJCTXQUIN COUNTY PUBLIC HEALTH SMVIC'8S ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 tJ� L (209) 468-3420 NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICemplets In Triplkstel APRICATIOM le HEREBY MADE TO SAIF SAN"AWN COUNTY FORA PERMITTO CONSTRUCT ANEVOR INSTALL THE MW DESCRIBED. THIS AP'UCATION IB MADE IN COMFUANCE WITH BAN "AWN COUNTY DEVELOPMENT TREE CHAPTE118-]110.3 AND STANDARDS OF BAN"AWN COUNTY PUBLIC HEALTH SERVICER. NVIROWEMAL HEALTH NWINON. .roe AOOREB&OR APNI 1506 (lY_'� T �2(� CRY LLo�r SIZE .1f OWMR'e NAME ADDRESS �TY�YFY" RHINE �.l O C��V CONTRACTOR �7�f�+/✓L�/� • ADDRESS �• /�.E, -/ -/�y�� LCF PHONE/- SUS CONTRACTOR✓/•�- 7 �J//J J/7 � ADDRESS/�/ L EAL4�-� // - "• lCI ��' PICNR�� TYPE OF SEPTIC WOW: NEW INSTALLATION ❑ REPNNAOOITION ❑ DESTRUCTION ❑ pIO SEPTC SYSTEM PEIMIITTED M MBUC SEWER IB AVAILABLE WITHIN TDO FEET OF BUILDING.) PMIC TEBTIEI I I MOW MANY Appeseen F INSTALLATION WILL 69WE REBS ENCE❑ COMMERCIAL OTHER ❑ NUMBER OF ETINNG UMTS:_ MIIe M OF DEDROOMS: "WOO M MKOYEES: i CHARACTER OF BOIL TO A DEPTH OF G FEET-4S9`1" � PEPMUMP SOIL CHARACTER: WATER TABLE DEPTH, SEPTIC TANKI R TRP ❑TY RES. CAPACITY NO.COMPARTMENTS no RGATMEFtT KANT❑ OMTANCE TO MSMFST: WELL FOUNDATION PROPERTY UNE LEFT STATION❑ tTTTKEE'''��- TYPE OF PUMP; SANO OR SEPARATOR IENCLOSM SYSTEMI LEACHI USE �m��MIENDTH OF LENE6 7-7S ' �'I�e �� DISTANCE TO NEAREST:WELL I!e !ECUNDATMN rPROPERTY USE FILTER eFD /❑VADTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PNOPERTY UNE SEEPAGE RTS ❑DEPTH ■ E NUMBER DISTANCE TO NEAREST:NRLL FOUNDATION PROPERrY UNE SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL PONDS ❑W DTII LENGTHDEPEII DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LIN[ I HEREBY CERTIFY THAT I NAVE PREPARED T11I8 PPIICATION AND THAT THE WORK YA BE DONE IN ACCORDANCE WTTN SAN JOAOUM COUNTY OFVINANC[S AND STATE LAWS,AND RULES ANDM NBOFTHEBANJOAWINCOU .HOME OWNER ORIJCENSED AGENT'S SIGNATURE CEFNMIES THE FOLLOMIM:-ICEIRIFYTHAT M THE PEIEOFMAFCE OF THE WORK MRM'ISCH THIS PE R I SRUM T EMPLOY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO 1I OMMAN'S COMPENSATION LAVH OF CALIFORNIA.- CONTMCTOR'S HMW OR A NO sun{ MCT 1 IATU RIDES THE F LOW W:I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS DVN W WMAN'S C PI LAW OF CALIM NI THIS APPLICANT MUST CALL ES HOMO IN ADVANCE FOR ALL RRINSLAREO INSPEOTN'"' COMPLETE GRAOANG BELOW. SIGNED X &' 4 "• TITLE. DATE: (V ROT RAN IDMW TO SCALER SCALE_--I' LOCATION OF"UBE SEWAGE DISPOSAL SYSTEM OR RIOMSED 1. NAMES OF STREETS OR WADS NEAREST TO OR BOUNDING THE PIgPERTY. 1. 3. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. E%PANRONION F SEWAGE THINDISPRAL SYSTEMS. -- 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN PROPER OF ONE HUNDRED FIFTY MON INCLUDING COVERED AHEAD SUCH A$PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. 1 h Ldp c�, P� 3I go O v -1 E �" + `' Jco F o4 3D ' o � o 9 5 'L FOR DEPARTMENT USS ONLY APPLICATION ACCEPTEDBV \I 'y'"�• �+ ��— '" DATE: A v (,(I L`( /�l TAM(,PE OR BUMP INSPECTION BY DATE FINAL INSPECTION BY E ADDITIONAL COMMENTS:g( 1O�C ��'�' E ACCOUNTING ONLY: NDE FACS PE CODE FEE INFO AMOUNT REW ITER CITE KF/CASH RECOVED DY DATE SR I P6PST HUMS, INVOICE F Pub.HAAlth Sery EOvllu 174)3/96)