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APPLICATION FOR UDUID WASTE PERMIT + SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES F ENVIRONMENTAL HEALTH DIVISION 3D4 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)460-3420 NOIFREFU GABLE PERMIT EXPIRES I YEAR FROM DATE ISSUE0 �{ � (CPRRPI\h is TrlPlieetal APPLICATION HI NEREBY MADE TO THE SAN JOADRN COUNTY FOR A PE/UPia 11T TO CONSTRUCT ANOMR rALL THE,WORK DESCRIBED,THIS APPLICATION IE MADE IN COMPUAWE WIIN CAN W E JOAOUCOUNTY DEVELOPMENT TITPTER TEE.CHA0-111 O,3 AND THE STANDARDS OF am JooAOUIN COUNTY PUBLIC HEALTH SERVICENVIRONMENTAL HEALTH DIVISION, ~• Joe ADDPEOMR APNf / �p ( l/ CRY F��dE�/�r �A/7�T LOT BILE OWNET'B NAME, I�I ,:eaJJ/Lrrl!AbpNE/ii / LONE � aAL'IC-fV�'d A ' CONTRACTOR �4L1 r lls�dl ----.a.OREa. '92-0 /Q -+/4 1ICf��'S �1 PHDNE� SUB CONTRACTOR - wppVES9 NCI PHONE / TYPE OF SertTC WOP: NEW INSTALLATION REPAfAADDITIOM❑ PEATRUCTION U Wo SEPTIC SYSTEM PERMITTED IF MOM SEWER M AVARASLE WITHIN 200 FEET OF BUSDNxV.) P61C TESTW I I HOW MANY Apps —f 1NSTALLATRON WILL SONE: MVIDEAVCE 0 COMMERCIAL❑ OTHER❑ RRNABER OP LIVING UMTS: ._L-NUMBER OF SEDROOMS:A NUMBER OF EMRDYEFA: CHARACTER OF BOIL TO A DEPrr"OF]FEFr: r�/ /PRlSUMP SOIL CHMACTFR: WATER TABLE DEPTH i SEPTIC TANAIaIEAFS TRAP ❑TYPEJI.IFOp_ CAPACITY r /�7 GrsBL� NO.COMPARTMEHT 1 PKO TREATMENT RA�TN--ENT 13 INSTANCE TO NEAREST: WE1L�� FOUNDATION PROPERTY]DIE UpT STATRUN LJ SME TYPE OF PUMP SAND OIL SEPARATOR]ENCLOSED SYSTEMI LEACHING LLXE NO.\LENGTH OF LINES OI"f E TO NEAE ,WELL,_MUNDATON.d[) PROFERIV UNE FILTERED (3M TH LENGTH DEPTH DISTANCE TO NEAREST:WELL rOUNCATgN PRDPERT✓LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PRDPEATY EINE SEEPAGE ATS ❑DEPTH aME NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PRoPEREY UNT— Fill SUMPS ❑WIDTH LENGTH DEPTH INSTANCE TO NEAREST:WELL_FOUNDAT10N PROPERTY UNE DISPOSAL PONOS []WIDTH LENGTH DEFrH OIBTANCE TO NEAREST:WELL FOUNDATION PROPERrY Lok — I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK NIRL SE DONE SV ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES ANO STATE LAWS,AND RUES AND REGULATIONS OFTHE RAN JDAOVLNCOUNTY,HOME OW NENORUCENSED AGENT'S STOHATURE CERTDTESTHE FOLLOYRHOT'I CERTIFYTHAT DTNE FE1vORMANCEOF THE WORK POR WHICH F THIS PERIAT IB ISSUED,1 SHALL NOT EMPLOY ANY PERSON D SUCH A MANNER AS TO BECOME RMJECT TO WANKMANS COMPENSATION LAWS OF CAUFORHIA.'CONTRACTORS HIRM OR BUBtONTRACTINO SIGNATURE CERTIFIES THE FOLLOWING:9 CERTIFY THAT IN THE PERPOTIMANCE OF THE WORK FOR VA41CH THIS PERMIT IB ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WOPKMAWS COMPFHBATION LAWS OF CAJFOTWIA.'THE APPICANT MUST CAL N HORR S IN ADVANCE FOR ALL PAQ%WFA IMVOCTNfHS.COMPLETE DRAWING BELOW. Ft - SIGNED N TITLE:- DATE L / G PLOT PLAN MRAW TO SCALE)SCALE- 'to _ . 1.HAMS OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DEPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY,WITH OWENB]ONS AND NORTH DIRECTION. WANSIDN OF SEWAGE DISPOSAL MA SYSTE . 3.DIMENSIONED OUTLINED AND LOCATION OF ALL EIBTIHG AND PROPOSED STRUCTURES, S.LOCATION OF WOOS WITMN RAaAS OF ONE HUNDRED FIFTY MON SNCLUDINO COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WARS. THE PROPERTY OR ADMIMNG PROPERTY. R ...+, ... .... :.. ,.. .. .. ..'....... -....�-.... .......: ...... ► G . ,._ UFS.... y 7 Z o ��r }1I�� ,Taf+/ uar A' t PAy ENS .................. ........... IIIA 111998 7" .. ..: hTl Jt�AQS11N EUIMTY .. .. Pl7tli3CHEl1LT1i-SETiYIGES.... ........ ........ _ FOR OEFMTMENT USF ONLY .� � APPLICATION ACCEFFED SY 1 AT,- E DATE: +1' , TANK.PTT Ofl BLIMP IHSPECTIONVFINAL\ �' //-- pY�' FAL INSPECTION BY - AT _J 1 ADDITIONAL COMM MO: a ACCOUNTING ONLY. MIDI FAG] ' w i PE COpE FEE INFO AMOUNT RFMlITED CLEC KASH RECEIVED BY DAT! SA lPDK\T NY14R\6V INVOICE/ 1 111 PUD.,Heath SADLY.•Ef1VU0.174 �v�