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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,304 EAST WEBER•AVENUE,STOCKTON,CA 95201388 12091 4693420 W-AEFUIFOABIF PEAMIF Ell P1AE8 1 YEAS FROM DRTE ISSIJ Q ICaIOp11t.I.TIIpIk.tll APPLICATION B NEWSY MADE TO IM BAN JOADUN COUNTY FUR A PERMIT TO CD NSTRUCT ANDMR INSTALLTHE WOW DEWRISM-THIS APPLICATION IS MARE IN COMPLIANCE WITil BAN JOAGLSN COUNTY DEVELOPMENT TITLE CNAPtFFA 9-1110.1 ANO THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC PIEMTH SERVICES,ENVPKINMEMAL HEALTH OWIION, JOB ADD .." CITY LOT Wlf ! -1119C. OWNER'S NAME' Ancows. ,y / �.[IGr LiAh7�rfsCS JTJA/ PHONE COWRACTOR � IL�/ _/��pA$� ADDRESS / —J-, e-7?'•I)vd UCI PHONE_ eI1eCOM11ACTOR � .�•.4 /`7/ ADOREeeok/G!!l� UC7 ?ZE—t92_.PNOMI� TYPE OF SEP=WORK: NEW INSTALLATION NE➢Mf"DITION❑ OF.6muc TION❑ ISO SEPTIC SYSTEM PERMIT-f ED W-'UNLIC HEWER 16 AVAILABLE WITHIN 200 FEET OF AURDINO.I PRIG tp fTRl I 1 HOW MAN' APPSnlfon! INSTALLATION WILL.ER/E: RESOENCE❑ COMMERCIAL$3 OTHER❑ NUMIJ A OF WINO UMTS: NOMISK OF�LSOROOMA: NUMBER OF 9APLO YIES: CHAMCTER Df SOIL TO A DEPTH OF 3 FEET: 4 Q(��FIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH J. SEPM TANXXAFASE TRAP 0 TYIEAAFO n'�a ! CAPACIrY � f/Yi ^_ NO.COMPARTMENT 9^L4 FKO TRER ATMENT AW 0 DISTANCE TO NEAA9AT: 11•LL .F�r FCUNDATON PROPERTY UNE- LFf STATION 0 SIZE TYPE DF PUMP BAND OLL SEPARA FOR IENCLOSID SYSTEMS LEACHING UNE ❑ NO.S LEA'OFN OF L1NE8yy` 1 'r OIATAW E TO NEAREST:WELL�L�'T f FOUNDATM)H PROPERTY LINE J r FILTER SED ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNOATKIH PROPERTY LINE T�- MOt-D® ❑WIDTH LENGTH__DEPTH DISTANCE TO NEAREST:WELLFOLHp ATION PROPERTY UNE SEEPAGE PITS ❑DEPTH am SOWER DISTANCE TO NEAREST:WELL FOUNDATION PRROPERTY 111E BtBLIMPS ❑WWIDTHTN _LENGTH /GDEPFH�/5/ .TANCE TO NEAREST:WETL g2Q"% OA7gH_j!tr-`7PNOFEREY UNE LT�r DISPOSAL LLOYDS ❑MOTH LENGTH OFPTH b16TANCE TO NEAREST:WELL lOUNOATION RROP'EHTV UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APRPCATKIN ANO TH•'T THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAOUII COLNTY OMNANCEB AND STATE LAWS.AND RIES AND REGULATIONS OFTNE SAN JOAOUIN COUNTY,HOME OWNER OR L)CLNSED AGENT'S GIONATU RE CERTNIEE THE IM FOLLONO:'I CERTIFY THAT M EHEO TNT PRMANCE OF TILE WORK FOR WHICH THIS P"W`T IS ISSUED.1 SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S CM-NNArtON LAWS OF CALIFORNIA'CONTR ACTOR'S HIRND OR SUB{pNT{Vt,CTIMO MNATURE CWTI TES THE FOLLDLNNO:'1 CERTIFY THAT IN IMF PEWORIAAM:E OF THE WORK FOR WMACH THIS PERMIT IB ISSUED.1 SHALL EMPLOY PERSONS SU"CT TO WOWMAN'S COMIEISATTMNNN LAWSOFCALIMANIA.' THE APPLICANT MUI'i CALL 24 HOVRZ IN ADVANCE FOR ALL RECAPPED ISOM TDI/N�6.�COMPLM DRAWMq WOO�W. OIONEO K Fri'I// �� _T,LE: ATE: �d^/✓ // ?y/'�,� ROT PIAN(DRAW TO SCALE,SCALE 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. I.LOCATION OF NOUN SEWAGE DISPTI M BYBTEM OR PROPOSED Z.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAOE DISPOSAL SYBTEMB. J.OIMENSIONED OUTLINES AND LOCATION OF ALL F)OSTINO AND PROPOSED STRUCTURES. E.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON BICLUDINB COVETED AREAS OUCH AS PATIOS,DPNTWAYS,AND WALLS. THE PROPFATY OR ADJORMNO rmpt TY• a� �T. nR .. ... : . Pi 3ilFlP ' � �. . .. � ,.• .rte Y . .. . .. ... . .. .. t ..: .... .:. .. .. AN JGrLU .... ,. ..: S E..�OUNTY.° .. ......PUL+ A SALT, ...... CNVIRONKN AL HE"DIVI,91gpl /J FOR OFIARTMDNF USE ONLY ARLICATOH ACCEPTED BY BATE: � � AffA TAW,RT OR BUMP IN6PECTtOH BY DARE I 1 FINAL INSPECTION RY OA1l ADDITIONAL COMMENTS: ACCOUNTNO ONLY: AIDE FACT R CODE PEFNFO AMOUNTREMIITm HEC !CASH RECEIVED.' OAT- LIpL ~ � INVOICE/ PUS.Heakh SAW.-Etwfro.174 131961