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S�IQ)WbUIN COUNTY PUBLIC HEALTH SERVICES � 'We ENVIRONMENTAL HEALTH DIVISIONC\�3S� P.O. BOX 388,304 EAST WEBERAWNUE,STOCKMN, CA VaOi- 88 ��JJ 12091408-3420 PON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete M Trlplleelel APPMATON IB HEREBY MADE TO TIRE BAN"AMIN COUNTY FORA PF MIT 10 CONRTRUCI AND/OR INRIALL 111E WORK DESCRIBED. THIR APR/CATION U MADE IN COMPLIANCE WITH BAN JOACUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9.11 J43 AND THE T�A/gyD/A�ROB//p/,F�/SAN"A/MIN CO1/1(y%y/Y' LJIC HEALTH BTN/C�EB,E(yyy1�RRlgNNIENTAL HEALTH DMRON. ,t JOB ADD SOUR ARIL C-�vn `.�,ry A ` H�/i/��'T�u.-}— �+,1/ CITY (,4 /2 LOT SIZE /1 /A�y&tz.,, DMNIER'e NAME��LA.L��F�I�'f�t T1`LKgn G1_ �I AODRESS `J�1"�E�—�—� PHONES "C/ IF CONTRACTOR C/2�r/qY.�L.)�e ADDRESS INTI PHo m1BCONrRACTOI%AA ,2T•Ll iia':'/'-�'/ �+-��AODRE66�� • • W iF LIC) TYPE OF 81RMC WORK: NEW INSTALLATION! REPNWAGNTION Cl DEATRUCTION ❑ 8f0 SEPTIC SYSTEM PERMITTED IF MOM SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TEATIFI I 1 HOW MANY ApPNeetlen INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL OTHER ❑ NUMBER OF LUNG UMTS:_ NUMBER OF BEDROONM: NUMBER OF EMPLOYEES: ^ ryr;�T+ TL.L•`. rn� 1� n��l CIO ABAEFEp OF SOIL TO A DEPTH OF 3 FEETMISUMP SOR.CHARACTER: / WATER TABLE DEPTH J�� AEPPT10'FAAWtDI FA&E TRAP ❑TY1 .Writ �i'J/.✓ZE'�r CAPACITY /IoCTICT� NO.COMPARTMENTS PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL 9 L•i FOUNDATION ' RgPERTY U N4STATION11 RI]f TYIYOrMMP nANII 011 RrPA1NlOn If NCA OmD SYPIIMI FOUNDATb l%,. 1'110PERr G� LEACHING UNE �CLNO.B LENGTH OF LNIEB V • (I PLD`4. DISTANCE TO NEAREST:WELL �`F/ TV UNE FILTER REO ❑YA RrH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPEIRY UNE SEEPAGE RTS ❑DEPTH an NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE RUMPS ElWIDTH LENGTH DEPTH DISTANCE TO NEAREST WELL MUNDATION PROPERTY LINE DISPOSAL PONDS ❑VADTH LLNOTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE I HEREBY CERTNY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOR(WALL BE DONE IN ACCORDANCE WITH SAN JDAMIN COUNry ORDINANCES AND STATE LAWS,AND RULES AND REODUTb THEeANJOA COUNTY.HOME OWNERORMENUD,AGENT'S SIGNATURE CERTIFIES THE FOLLOWINO:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH THIS PERMIT IS ISSUE I SHALL NOT E PLOY ANY PERSON m SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUMMIA.' CONTRACTOR'S HIRING OR SU -C RACTING el TUBE CERTIF 8 THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE W OM MR WHICH THIS PERMrt 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO W 'B C NPEN 1 LAWS OF (FORMA.' THE APPLICANT MUST CALL 24 NOUNS IN ADVANCE FOR NJ REOURED INSPECTIONS. COMPLETE DRAWING BELOW. pQ' SII -4 t. \J 8 NED% Tl/' / /� `� TITLE: �1 GATE: S ROT RAN(DMW TO SCALE)SCALE 'IS 1. NAMES OF STREET$OA ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS OWN AS PATO$,DRIVEWAY8,AND WALKS. THE PPOKBTY OR ADJOINING PIIOPE T . pRLYMENT Oc Orf—F-WW 's (10 AUG 31999 .. ... _ PUBLIC 11AL SERVICES NTAHEALTH DIVISION'hONNVIRONME /1 p III pEVMTMMT USE ONLY /I z ( �J APPLICATION ACCEPTED BY `Ej/�'J�/"•Y/`- /V .'�`-'KLI[JEep DATE: ,,lLl/lJ.\l�ll//T TAM(,PIT OR BUMP INSPECTIIlOOJJ_II4BY��^,1 DATE / / FINAL INSPECTION BY /. ATE ,, �nnA—/— ADDITIONAL COMMENTS: vim- ACCOUNTINO ONLY: I AIDS FACT R CODE FEE INFO AMOUNT REMITTED CIIECK CASH BECEVEO RY DATE SA/PERMIT NUMBER INVOICE P 2 to IT5Z cb I Pub.Health Sew.-Enviro.174(3/99)