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P.O. BOX 388, 446 .. A. SAN JOAQUIN ST, STOCKTON, CA 962010388 <br />(209) 468 3420 <br />NOR -REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />' IGmpMM w TF40Naul <br />AFP=ATION IS HERESY MADE TO THE SAN "AWq COUNTY FOX A PEWIT TO CONSTAMT ANOMM INSTNI THE WON( CEWASED. THIS ANMXATpN 19 MME IN CONNUANCE NTFH SAN <br />JOAWN COUNTY OEMLOMFM TRI -E. CNAPTFA <�� 9-1110.3 AMID THE STANDARDS OF SAN A3AOUIN COUNTY MINX HEALTH SERVICES. ENV AON/MENTAL HEALTH OIAMN. <br />AB AOOIIESSNfl ARjI�I �� l . ;JA--&�..(^-�.1f. IVP /9 CTI y�n /C1 LOT SQE_ <br />M <br />OWNER'S NAE RL-(liT n )/fin �l"J AOOR59 9�f ;11196; 1)-1ILII 1Z d MORE 3G 7 17/l <br />IIS <br />AMM <br />AES <br />{ <br />PQM 3`°eL b fis <br />W <br />Fri <br />V T36X <br />PAYMENT <br />I:rr.'r,Ew`r <br />SEP - 1 1995 <br />PUSLIC HEau F ,,ifU <br />,-, <br />-vs R?vb+E'j-A; H A Fk DPVYI5r1\ <br />333 <br />�If-`J`M-_^µ FOR DEPMTMExT DSE ONLY �] / D 6 �/ <br />APRIC`TION ACCEPTED BY C ' I Y'1 /�� DATE: I ./ /� — 6PEA: 2 1 L <br />COMMROX `L1 FC. V_1 CIU 710-V ) hn /SGS ADDRESS MI PHONE <br />) 1 I JJ J <br />TYPIP IY//)l1 JjITADOR58 I>OS S. bPL SAKI SJ MONF <br />SUS COMMCTON US YiI ,,4E�I <br />TYPE Oi SVM WOXI[: XEW INSTALLAINIX XVNRIAODITIOX❑ OF{TImm.❑ <br />NO SEPTIC SYSTEM FERNTTEO IF MOUC SEWER IS AVAI A WITHIN 200 FEET OF SUILDINOJ FVC TEITI.I l 1 HOW MMT <br />� <br />AFMo•Yon • ' <br />gfTM1ATXIX WNL t6Ni: RESIDENCE IQ COMMERCIAL ❑ OTHER 13 <br />D/ <br />MIM61 OF IMNO IINTB:_NUXMd OF XFIMOOMi: 3 XDMtDE OF ESMO A / <br />CHARACTER OF SNL TO A DEPTH OF 3 FEET: MIEUMP Wit CHARACTER: WATER TABLE DEPTH <br />- <br />^ <br />SVFIC TANMMRFAtF TRW ❑TYPFAIFO20� J CAPMTI /W!O NO.COMPMTMEM6 <br />_ <br />fi�nn'''' <br />PEO TREATMENT PIANT ❑ DISTANCE TO NEAREST: WELL�_Ct FOUMAT.N C2 r --t- P OPERTY UNE <br />RFT STAMM Q N2E TYPE Of w BAND OIL SEPARATION IENCIASED SYSTEMS <br />� ./� <br />IEACMMO UNG 13 NO. S If HSTH OF LINES -S — 41, � DISTANCE TO NEAREST: WELL,&y & FOUHOATION�L PROPERTY ME 4 - <br />FILTER SOD 13WIOTN IENSTN DEPT% DISTANCE TO NEAREST: WELL MMOATON PROPERTY UNE <br />FILTER <br />MOUIIOFO ❑WWTH RENOIR DEPT% DISTANCE TO NEAREST: WELL FOUNDATION flOIEAtt UNE <br />SUSAN[ "To .3( ME <br />❑WIOTIIIFNSTN DETMRg6FNCE TO NFARE6T: NIILTONPROPERTI'I1NE <br />OIVOSAL POMOS ❑ WIOTX MKITH DEPTH DISTNICE TO NEAREST: VIFLL FOUNDATION NOPERIV INE <br />1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCAMN AND THAT THE WOW WXL SE DONE N ACCORDANCE WITH SAN JOAWIN COUNTY ORMHANCES AND "An NWS. AND IWIES <br />AMl REGIMAMAS OF THE SAN JOAOM COUMY. HOME OWNEROR WENSEO MFR'SNSNATME CEFTEIES THE FOLLOWFKI:'I CFNTFYTHAT N THE RTOWAAME Of THEKOIK FORWHCH <br />THIS PFN.ET N ISSI I NULL HOT EMPLOY ANY PERSON N INCH A MANNER AS TO BECOME SUBJECT TO WOfl(MAN'S COMPENSATION LAWS OF CAUTOPNIA' CONTPKTOR't HOMING OR <br />SUBLgfTMCTINO NONANRE CERTIFIES THE FOUOMNO:'I CERTIFY THAT N THE KRIFONAA RIE OF THE WOR( FOO WINCH THIS PERM IB SOARED. 1 WAL EMRDY PERSONS WSIECT TO <br />WORKMAN'S CO IAWS OF CAIJMR IA.' THE RFRICPNT MOST CML N WHAM E ADVANCE FOR ALL REW/IRREED_ WSPEDMIS6. COMPETE DMARING <br />(NFENNS�AMN ]F30W. <br />SIGNED \//L '. _ TNIE: <br />- <br />POT I IDMW TO SCAIEI ELAN Rao. <br />1. NAMES OF STREETS OR ROADS NEAREST TO OR VOMOIND THE PKOMP TY. LOCATION OF MUSE SEWAGE DISPOSAL.SYSTEM OR PROPOSED <br />r <br />3. OUTME OF THE PROPERTY. WTH gMEHSONS AND MONTH DIRECTION. "PANSON OF SEWAGE DISPOSAL SYSTEM'. <br />3. gMEN6ONE0 OY MFS AND SOLATION OF ALL EXISTING AND RVPOSED'TM/CTVIEI. I. LOCATOR OF WELLS WTHN RADIUS Of ONE HUNDRED FIFTY R.OH <br />.Lm. COVTRED AREAS SUCH AS PATIOS, DRIVEWAYS. AND WALKS. THE PROPERTY OR AD.ONHC PROPERTY. <br />IIS <br />AMM <br />AES <br />{ <br />PQM 3`°eL b fis <br />W <br />Fri <br />V T36X <br />PAYMENT <br />I:rr.'r,Ew`r <br />SEP - 1 1995 <br />PUSLIC HEau F ,,ifU <br />,-, <br />-vs R?vb+E'j-A; H A Fk DPVYI5r1\ <br />333 <br />�If-`J`M-_^µ FOR DEPMTMExT DSE ONLY �] / D 6 �/ <br />APRIC`TION ACCEPTED BY C ' I Y'1 /�� DATE: I ./ /� — 6PEA: 2 1 L <br />