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APPLICATI OR Liam WASTE PERMIT _ J JOACRWA11NTY PUBLIC HEALTH —.RVICES IDIMI Sf EJJWRONMENTAL HEALTH DIVISION �A��QAQ�11tit(1TJTi1Y.}T }111 ` 30d � AVENUE, STOCKTON, CA95202 (209)4 (111611•REFURDROLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (COMPIFtB ID Triplk.tB) APPLICATION 18 HEREBY MADE TO THE BAN JOAOUIN COUNTY MR A PERMIT TO CONSTRUCT ANOMA INSTALL THE VVV K DESCRIBED. Me APPLICATION M MADE IN COMPLIANCE WITH BAN �IJOAUUIN COUNTY DEVELOPMENT TULL CHAPTER/B-11110.3 AND THE STANDARDS OF SAN JOAIMN COUNTY MOM HEALTH BEIMC IS,EPNNIONARNTAL W,,,YN DIVISION. JOB ADDREBemn ATNF. / I l , , ?C(;e Sic � � CITY /-Cg / Art- ----9 r^ OWNER'S NAME_jB"7. l/1Jli.( /F I E }C Z. �(^ [] lOi SI7I n/'[�'L J+I 'C LE 1'h.l'1. (�'LVL!'.�'1. AUp1E88 T-'C).-3!,1X � 1�/ � T,([t J� /�� 1.��2 J �F R10NF / CONTRACTORS 1 C�k(°D'T-'�/VC ZXN,7>;- - yL..2�.'� LICE /PHONE & J J 7 J BUS CONTRACTOR ADDRESS LICE PHONE TYPE OF SEPTIC WOKS: NFAI INSTAUANON RFPAIVADOITION ❑ DESTRUCTION IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUID M, PSIIL TESTHI I I NOW MANY Apse F INSTALLATION WILL SEINE: RESIDENCE❑ COMMERCIAL OTIAE NUMBER BE WINO UMTS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEM:--, CII lFn OF sett TO A DFPIII OF O PEET(� ��/} ET[BUMtPt SOIL CHARACTER I( ' 4A 1. WATER TABLE OEPPH � - TMTANk[ $F TMP ❑TVPENALF0. iV"I —�Lf I�— CAPACITY BOC) I NO.COMPARTMEMB OKG TREATMENT MMT❑ DISTANCE TO NFMFBT: If. WELL ICk'N ]R FOUNDATION A PROPERTY LOU UFT STATION❑ SIZE TYPE Pf_f SAND OIL SEPARATOR ENCLOSED 6YSTEMI LEACHING UNE �,W.A LENOTH OF UVEB - TF� _��nC. I, DISTANCE TO NEAREST:WELL It IC) FOUNDATION PROPERTY UNE J FILTER DEC ❑WOrH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY'UNE MOUNDEDfffO WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDAMN PROPERTY UNE SOURCE IN Ry DEPrN [,ZS I ME S!_ri NUMBERN"AHCE M NEANEBT:WELL �• C/�. MUNDATMN 41T 2 ( PROPERTY UNE SUMPS /❑LNUrH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL PONOS ❑WITH LENGTH DEPTH "STANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICAMN AND THAT THE WOK WILL BE DONE IN ACCORDANCE WITH SAN JOAWIN COUNTY ORDINANCES AND STATE LAWS.AND MULES AND REGULATIONS OF THE SAN JOAGRIN COUNTY.HOME ROn MENDED AGENT'S&ONATURE CERTIFIES THE FOLLOMNG:'t C ERTIFY THAT IN THE PERFORMANCE OF THE NOEL FOR WHICH THIS rt U ISSVE¢t p1ALL710=[RAPTOR ANY PERSON SUCH A MANNER M TO BECOME SUBJECT TO NbIKMAN9 COMPENMTON LAN'{OF CALIFORNIA.- CONTRACTOR'.NINNO OR BUB ONt U=ATI C e T11E FOLLOWING: 1 CERTIFY THAT p THE PERFORMANCE OF THE WOE(FOR WHICH THIS PERMIT le ISSUED.I WALL EMPLOY PERSONS BVBJECT TO MroR(t[MANS OMMMATIO L •OPRCAUPOMBA.Til MICART MUST CALL 24 HOW IN ADVANCE EOR RLL SECURED INSPECTIONS. COMPLETE DRAWING BELOW. )[1.\ \ � SIGNED / �~\ - _ \ TITLE: �4/':"�'\ DATE: CIS _ •_� -. ..� U PLOT RAN(DRAW TO SCALE]SCALE •Re 1. NAMES OF STMETS OR ROAD NEAREST TO On BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE D UO8A SYSTEM On PROPOSED 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE pU08A SYSTEMS. 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, a. LOCATION OF WELLS WITHIN RABBIS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH A8 PATIOB,DRIVEWAYS,AND WAIS. THE PROPERTY On ADJOINING PROPERTY. TA� �rGigr`'h PualIt,IIL IrlrRwcEs I1; �� ,�- ENVIRGNMI FIiAL I,TPI �tl 4� >v A ` qq I, U , i IAT rA .... II4 dip FOR DEPARTMENT WE ONLY AITLICATION ACCEPTED BY DATE: 1 AIA.FIT OR BUMP INSPECTION Br' %- '�.,---./ DATE�( CT FINAL INSPECTION by DATE II 1� I ADONTIONALCOMMENTB•�sN(._s:lC L!.) �(lL �''� L^1' IV- \� SIL/LJC(l 1 LiA , r J Q / S Z '\ ACCOUNTING ONLY: ADI FACE h� PE CODE MINA AMOUNTRURITED CIRECILIMABH RECEIVED BY DATE MIPESNITNREAeEII INVOICES Pub.Health Saw.-Enviro.174(3196)