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!�F �(CPTIF WASTE PERMIT PAY( ^ANT &AN Jd".10}fN.. /NTS PUBLIC HEALTH SERVICES REC' ED EN- ME HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 SEP 5 2000 (209)468-3420 ( , //'']]''� SAN JOAQUIN COUNTY NDN-REFUNOABIF PFRMR—E%MRES 1YFAR FROMLATE ISSUED PUBLIC HEALTH SERVICES VIRON ENMENTAL HEALTH OMSION IC{RPNe Is Tr4Bt{t1) APPLICATION H HEREBY MADE TO THE{AN JOAOUW COUN7`Y FOII A PERM TO CONSTRICT AND/OR MtTALL THE WORK DESCRIBED.THIP MVEICATION M MADE N1 COI./RUNC[Wrt {AF7 •OAOUIN COUNTY DEVELOMENT TTTLB.CHA/PIER B•1110.3 AND THE rT lDMO{iO/F SAH7JOAONN COUNTY PUBLIC 11[ALTN/ERVICEB,{BIVBOEMiIl1EEK IffKTN DIVMIDN• OS ADORES SAVR APl# ,-�u�•1 -�J1� 'r -W+)/ 71 ,L / dT,r�Y(1,rI;.,r.�C '1 EDT EQE }r PUSHER'S NAME ilI ADORE 89 IL r'T C f '.�PHONE J 7 � CONTRACTOR`<<_ -•::'i I A.- -I�r{r l•J/fi CYT ��/ _ LICI MDNF7fADDK SS UCS '�� VB CONTRACTOR . =•FY►S OF SEPTIC WORK: NEW INtTALLATIOX❑ RFDAIR/ADdTION❑ D4TRVC710M O IAO/ERIC SYSTEM PLRMfTTED IF PUBLIC SEWER IS AVAMBLE W .IN TOO FEET OF BWLZRNO.I i R J/ l 1 �TrT�1 I HDXf MART ,r A►SEtttw 0 t, YSTALLATION WILL SEINE: RESIDENCE❑ COMMEFICIAL❑ OTIIER❑ L' •R !�E( C�1 Cr 1 ' - -y� <�•Jl.LtFV'��.J E'!nl�:.[ji�5 tli-F /.'.FI�/r /W{N Of UVpda UWT{: NUMSM OF BEDROOMS MIIA{[R tM NSPLOTEL: - .t BL CHARACTER Of SOIL TO A DEPTH OF 3 FM' PIT/eUMP SOIL CHAIUCTM WATER TAE DEPTH Ll SEPTIC TANE/ORSASS TRAP ❑TYPE/MFO CAPACrry NO.COMPARTMENTS X[G TREATMEKT MM❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE LIFT STATION❑ PZE TYPE OF PUMP BAND OIL SEPARATOR IENCLOSED SYMMI 1/LOb NO UNI ❑ NO.S,LENGTH Of UNE$ DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE ALTER RED ❑WIDTH IENOTN DEPTH DISTANCE TO NEARER:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENOTN DEPTH DISTANCE TO NEARER:WELL FOUNDATION PNOPERTY LINE &MAGI RTS ❑DEPTH RAZE NUMBER PRANCE TO NEARER:WELL FOUNDATION PROPERTY LINE PERTY UHF LUMPS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAPEST:WELLFOUNDATION PRO 'YNItPO{AL ANDS ❑WIDTH LENOTN OEl'TII DISTANCE TO NEMER:WELL FOUNDATION PROPERTY LINE 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULE$ UID REGULATIONS OF THE SAW JOAOUIN COUNTY.HOME OWNER ORUctNBED AOENT'S SIONATURE CERTIHES THE FOLLOW WO:'1 CERTIFYTHAT IN THF PEIfONMANCE OF THE woo FOR WHICH T/IIS PFMRIT it ISSUED,1 SHALL NOT EMPLOY ANY PERSON M OWN A MANNER AS TO BECOME SUBJECT TO WORKMAN'S CMPEJHATION LAWS OF CAUFOINIA.'CONTRACTOR'S HINNO OR THE WORK P014 WHInH THRS PERMIT 15 ..110/SCMAN't COIMPEN�ATTOUN UW{OF CAUfORFIIA. 7N[•IARUCANT MUSTCERTIFY THAT CALL71 HON THE OUR{�EICAOVfANCE fOR ALL R[OIJ•tED INtP[CTON/(COMPLETE DRAWIHO SELOWWNt CTTO TITLE: BIONEDX JI 1 ROT RAN IOMW TO SCALA SCALE 1LOCATION OF/ROUSE SEWAGE DIIPOM SYSTEM OR PRDPOBEO 1. NAMES Of ST11EETt Opt ROADS M/1FIEST TO OR BGIIPlpING THE PROPERTY. .EXPANSpN OF SEWAGE DISPOSAL SYSTEMS. 91.OUTLINE OF THE PROPEM•WITH OIMENMQMS AND NORTH DIRECTION. S.LOCATION OF WELLS VRTHXJ RAMS OF ONE HUNDRED FIFTY FT.ON 3. DIMENSIONED OVTUNES�ND'LOCATIAN IOP ALL EXNTINO ANO PROPOSED a*RUCTURE S. THE PROPERTY OR ADJOINWO PROPERTY. INCLUDING COVERED MEAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. ...... _ t -7 ,.....n / .. ... 4 .....< - ..� elk r r — ,,_. ............f I s. r ........ - �,. t S . ........:........ w s .i ...._......: :..b.... kc.E.e.o-. .... lC. .LCL .......---. ........................... . / FOR DEyARTM Ute ONLY •'1\_,�f^f'f��•i/' G �I ,, -.`.HI l DATE: 9� no AREA: / APRUGL710N ACC[PTED eV f� FINAL INSPECTION BY DATE I I TAPLT OR SUMP INSPECTION BY GATE l I MC ADDITIONAL COMMENTS: ACCOVIITINO ONLY: NDS fACJ PE CODE FINFO AMOUNT REMITTED CHIC" SH RTCBVFD■Y DATE M/INERST NIl,6Bl INVOICE II Pub.Heatth Sol•E.,Afo.171(356) {