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>3 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION INSPECTED E3(J( lVUT <br /> P.O. BOX 388, 304 EAST WEBER-AVENUE, STOCKTON, CA 9520!388 SIGNED <br /> (209) 4693420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> IComplNb In TTipficBtsj <br /> APPLICATION 18 HERESY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED, THIS AH ATION 18 MADE IN COMPLIANCE WRN NNW <br /> JOAOUIN COUNTY DEVELOPMENT TELL,CHAPTER 9-1110.3 AND THE STANDARDS OF(�BA�NJ/�OAWN COUNTY PUBLIC HEALTH SEfl/VVFES,ENVIRT/ONNMENTAL HEALTH DIVISON. <br /> JOB ADDRESS/OR APNI V / ZiT ' H <br /> OWNER'S NAME�i E F'T1YYY'I At, /S Z ✓� ADDRE69 �,.�N(% '-F J�i LVlf` CI •7 /` �I P1gNE �')�.'/l S�7�fF �I,} <br /> CONTRACTOR I �/V ADDRESS <br /> UCl RIONE <br /> SUBCONTRACTOR �U ADDRESS LIC• PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPANVAODITION ❑ DESTRUCTION T7J�F' <br /> INO SEPTIC SYSTEM PERMITTED I PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BURDING.I /I,'/� PEW TESTIvI 1 I HOW MANY <br /> / ' 1 AooNemm�s <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL ❑ OTHER ❑ , <br /> NUMBER OF WHO UNIT$; NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH Of 3 FEET: PR/SUMP SOIL CHARACTER! WATER TABLE DEPTH <br /> SUM TANKAOREASE TRAP ❑TYPEMFO CAPACITY W.COMPARTMENTS <br /> WO TREATMENT RANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> UFT STATION❑ 512E TYPE OF RUMP SAND OIL SEPARATOR RENCLOSED SYSTEM) <br /> LEACHING UNE ❑ NO.S LENGTH Of LINES DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE RTS ❑DEPTH SEE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREGT:WELLFOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APRK:ATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUW COUNTY ORDINANCES AND STATE LAWS.ANO RULES <br /> AND REGULATIONS OF THE SAN"AWN COUNTY.HOME OWNER ORMENSED AGENT'9 GIONATLME CERTIFIESTHE FOLLOWING:•1 CERTIFYTHAT INTHE PEPFOPAIANCE Of THE WORK FOR WHICH <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER A8 TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFOWAA.• CONTRACTOR'S HIRING OR <br /> SUB CONTRACTINO SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALNORMA.• THE APPUCANT MUST CA 4 HOURS IN ADVANCE FOR ALL REQUIRED INSPECMNS. COMPLETE DRAWING BELOW. <br /> SIGNED X TITLE: [r�i'>..� iDATE: <br /> ROT RANO TO SCALES SCALE •to <br /> I- NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE RRFY. M. LOCAMN OF HOUSE SEWAGE D1SPU9AL SYSTEM OR PROPOSED <br /> T <br /> 2, DUUNE OF THE PROIT <br /> PROPERTY,WITH DIMENSIONS AND NORTH dRE TON. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. OIMENSIONEO OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION Of WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATOB,MVEWAYB.AND WALKS. THE PFOPERTY OR ADJOINING PROPERTY. <br /> MAGKVILLE 361 TPT <br /> L13ERTY ROAL) <br /> — • <br /> i {t <br /> I I,� (i � •i ,I. <br /> PF.OPOS�.D LOT LIN= _ l\�• <br /> I � <br /> N o ILI <br /> INSPECT D C;U TNOT <br /> ` - PAR:,EL•2 IW Iii SI NEL) <br /> H- <br /> N <br /> I IW <br /> LEXISTINS LOT L[HE J <br /> k <br /> i <br /> C.;E <br />