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APPLICf—`N FOR 1.11013 WASTE PERMIT SAN JOAOU. .BOUNTY PUBLIC HEALTH SERVICES F ENVIRONMENTAL HEALTH DIVISION f 304 EAST WEBER AVENUE,STOCKTON,CA 95202 ''� (209)468-3420 F �lkJ.� LS 316 PIOx�REEII#DARLF PERMIT EXPIRES I YEAR FROM DATE ISSUED 11�Y ICDmpiad in Trplicalml APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMTT TO CONSTRUCT AN13MM INSTALL THE WORK DESCRIBED, THIS APPLICATION PS MADE IN CoMRJANCE WITH SAH JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUIH CDUNiY PUBLIC HEALTH SERVICEB,ENVIROMMENTAL HEALTH DIVISION, q JOB ADOBE611MR-tw, I 2s `��' K 'T C.:Y ��LOOT 812E N[� OWNER'S NAME+t1 1 ~ . 1-ADDRESS S}- R70NEJ}V"�- -r� Dkij CONTRACTOR �4i,P1�f ADDRESS LICI PHONE BUD CONTRACTOR J./2' AOUREES LIC/ PHONE Fj TYPE OF SEPTIC WORX: NEW INSTALLATION❑ REPAIRIADornoN DESTRUCTION MID SEPTIC SYSTEM PERMITTED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTHI I I HOW MANAppBwticn I INSTALLATION WILL SEINE PESMENCE❑ COMMERCIAL❑ OTHER❑ NUMBER OF—110 UNITS;--I;_NLIMBBT DF BEDROOMS:^ :2^NLkAB61 OF EMROY1Ft: CHARACTER OF SOIL To A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: +. WATER TABLE DEPTH SEPTIC TANN1ESISAaey .POIN' ❑TYPFIMF6 O JV J � CAPACITY 12-d NO.COMPARTMENTS Z PXG TREATMENT PLANT❑ DISTANCE TC NEAREST: WELL FOUNDATION PROPERTY LINE F UFT STATION 0 S72E TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYBTEMI LEACH"UNE ❑ NO.S LENGTH OF LINTS DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE SUER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NFAAFST:WELL FOUNDATION PROPERTY UNE MOUNDED 10 -1 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE SEEPAGE HTS Q DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE W 7 6UNSPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNOATNON PROPERTY UNE DISPOSAL PONOS ❑4430TH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE _I HEREBY CERTIFY THAT 1 HAVE%IFPARED THIS AMJCATIaN AND THAT THE WORN WILL BE DONE IN ACCORDANCE YATH SAN JOAOUTN COUNTY ORIXNANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE DAN JOAOUINCOUNTY,HOMEOWNEROR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT INTHE PFrIFOFIMANCEOF T HEWOHL FORWHICH IIT le ISSUED,1 SMALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AB TO BECOME ALMJECT70 WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRJNO OR F"'PESUS-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWINO�'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH TNIB PERMIT 18 IBBUEO.I SHALE EMPLOY PERSONS SUBJECT TO WORKMAN'S coMPEH TION LAWS OF CALIFOR NIA.' THE APPLICANT MUST CALL 2A HOURS IH ADVANCE FOR ALL REOISREO INSPECTIONS.COMPLETE DRAWING BELOW, "M SIONED%� _ TITLE: pU 9 Ft LffDATE: 101,14 F'. PLOTMN(DRAWTOSCAM"CALE-1.NAMES OF STREETS OR ROAD-NEAREST TO OR BOUNDING THE P OPERTY. i.LOCATION of HDUBE SEWAGE nISP M;A SYSTEM OR PROPOSED 2.OUTLINE OF THE POFERTY.WITH DIMENSIONS AND NORMDIRECTION. EXPANSION OE SEWAGE DISPOSAL BYBTEMa.3,DIMENSIONED OUnME6 AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6.LOCATION OF WELLS WITHIN MAIMS OF ONE HUNDRED FIFTY FT.ON �l INCLUDING COVERED AREAS SUCH AB PATIOS,DRIVEWAYR,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. 1 .,,. .. .. ...,. {.i C V I . ... ... �y ........... 7 �3 :. . ......,.. F d { i ..................... ..........w . ............ f I'lxf� ....k-1. . ...... ..... .............. ...... ........ .... .. . ... _ ...... ..... ........ .................. .......... ..... . . T ....... .. .... �' ... ... g (a�i rc .... �E�8v,0v*? 0a rx,.o d ........I ... : n .. ......... ....,... ........ ,..... /J FOR DFPAPTM-T USE ONLY 7 PAPFUCATION ACCEPTED BY L- DATE'_ AREA' PANIC,PRT OR SUMP INSPECTION BY, ATE v! 1 FJNAL INSPECTIONB� DATE I ! _ ADDITIONAL COMMENTS: L..... NO ONLY: AIDE FACT PtCODE FEE INFO AMOUNT AFMIITED GNECX/IC 6H no:ERYD]BY DATE SR lPBSr11T NLMSBS INVOICE/ 1I G�±— z1 tc'°! e Z7c1 Pub.Health Serv.-Enviro.174(3/96) /� _ 1] 1 �-77n �r f (.�S �� '01 C.�d� 1 l flr U '