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0 06 <br /> APPLICATION FORuauio WASTE PERMIT 5 , <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH ScAV119�,Fs v, �P7 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON, CA 199202­�, <br /> (209)468-3420 MAP, 2 2 1999 <br /> ffOR-REFUNDABLE PERMIT IMPORES I YFAW FROM DATE ISSUEDH;'L A <br /> N <br /> (Complete In TrIplicatal f <br /> APPLICATION 19 HERESY MADE TO THE SAN jOAOUIN COUNTY FOR A PERMIT To CONSTRUCT ANDJOR INSTALL THE WORK DESCRIBED. THIS A Misa;!"t <br /> Ii1 L1ANCE WITH BAN <br /> joAcum COUNTY DiEvaokew TITLE.CHAPTER 0-1110.2 AND THE STANDARD@ OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DMSPON. <br /> 308 ADDRESMR APNO CITY 6 U44,,ad LOT <br /> OWNER'S NAME AcwEss Pe!�-AVVV Ae- 94q - 6f,6F- PHONE S-/0&yL7tS*— <br /> CONTRACTOR �AyADDRESS VOS-9Z) )' � 5ff-E02 e' i Ljc# 6--321 15-1 PHONE Y,70 V&I'I7 4D <br /> SUB colltp.4=011 ADDRESS —Lie# <br /> TYPE OF SEPTIC WORK- NEW INSTALLATION C1 REPAUVADDITIO;V Onvitucnom 13 <br /> M SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) POW TESTI111 I I NOW MANY <br /> ApOlmdun IV <br /> INSTALLATION WILL SERVE- RESIDENCE 0 COMMERCE A4)6 OTHER 13 <br /> NUMBER OF LIVING UNITS- NUMBER OF BEDROOMS: NUMBER OF PAPLOYEFA, <br /> CHARACTER OF SOIL TO A DEPT"OF 3 LIMAIPOIL CHARAM41 )Xf A WAtERABLE OM"- <br /> BEIIRC TANCIBRF f TRAP [3 TYPE/MFG 1-7-2 L-el�!ja I CApACITY,NO.COMPARTMENTS <br /> PKG TREATMENT KANT El DISTANCE TO NEAREST: WFXL—f FOUNDATION PROPERTY LINE <br /> LIFT STATION 13 sin TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM — -" r <br /> LEACHING UNE 0 No.S,LENGTH OF LINES DISTANCE TO NEAREST,WELLI.g? FOUNDATION PROPERTY LINE <br /> FILTER BED 0 wwrHLENGTHDEPTH DISTANCE To NEAREST:WELL FOUNDATION_PROPERTY LINE <br /> MOUNDED 13 MDTpt_LENGTH_DEPTH H DISTANCE To NEAREST-WELL FOUNDATION_PROPERTY LINE_ <br /> SSIEPAOIE PIT$ [3 Dtpr"—emk—HUMBER DISTANCE TO NEAREST:WELL - e <br /> SUMPS WIDTH LENGTDEPTH Z LtnFOUNDATION PROPERTY uNk_ <br /> H eTAw-E-roNEAFtEs-r:WELL46_i)_FOUNEMTION- --;,- PROPERTY UNE_ <br /> _Lj� L <br /> DISPOSAL.PONDS E3 WIDTH_LENGTH DEFT"_DISTANCE TO NEAREST:WELL FOUNDATIONPROPERTY UNE_ <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JDAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULAMN9 OF THE BAN JOAOUIN COUNTY.HOME OWNER ORLICENBEC,AagNTIS.MONATURE CERTIFIED THE FOLLOWING:*1 CERnFYTHAT INTHIE PERFORMANCE OF THE WORK FOR VWMH <br /> 11 TOMS PERMIT 18 ISSUED,I SHALL NOT EMPLOY ANY PERSON 01 SUCH A MANNER AS TO KVWM rj&MCT To VjOrAMAN-p COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR-111 NNW OR <br /> sUB-Comnwnm MNATURE CERTIFIES THE FOLLOWING:I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 10 ISSUED.I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.* THE APPL30ANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REGUIREP INSPECTIONS. COMPLETE DRAVYING BELOW- <br /> 4 <br /> SIGNED X <br /> TITLE, DATE., <br /> ? L 0- <br /> U WIT PLAN(DRAW TO SCALE)SCALE_- <br /> to <br /> 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 1. NAMED OF STREETS an ROADS NEAREST To On BOUNDING THE PROPERTY. <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL INYSTIEM9. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND IMPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY Fr.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DIUVIEWAY6,AND WAIXG. THE PROPERTY OR ADJOINING PROPERrY. <br /> .................... ... .... <br /> ........... <br /> ................. <br /> ........... ............. ....... ............ ....... <br /> .......... <br /> 0-..... .... ..... ....... <br /> ....r <br /> ............. <br /> ............. ........ ...... <br /> . .......... ... <br /> . ............ ............ <br /> ................ ................ <br /> .. ......... <br /> ............. ....... . ...... ........ ...... <br /> .......... ...... ...... <br /> .................. <br /> .... ...... ... ......... <br /> .......... <br /> .................... ....... <br /> .......... .... .... .. .. <br /> ..... ...... .... ............. ol........... ......... <br /> ........... ....... <br /> ............. <br /> ... .......... ........ <br /> ........ ... ....... ....... <br /> .................. .......... <br /> .. ........ <br /> ............. <br /> ff <br /> Z <br /> ........... <br /> ............... .I ............. <br /> ... ........ ......... ....... <br /> ............ <br /> ........... .................. <br /> ............... ...... ....... <br /> -P................... <br /> ................ <br /> ........... V <br /> ............ <br /> ........... <br /> ........... <br /> ...... .......... AR!2 <br /> ...... .... <br /> ........... ...... <br /> ........... <br /> .................. <br /> .......... ............. <br /> . ............. <br /> .......... <br /> N <br /> .......... ........ ........ <br /> .. .......... ...... ............ ...... <br /> R DEPARTMENT USE ONLY <br /> APPLICATION Ae'rFgrrFn BY DATE. ­2-3 -,:5? IAREA: <br /> DAT <br /> OR INSPECTION BY DATE3 JZ Ile/rINAL INSPECTION BY 11 <br /> & I <br /> ADDITIONAL COMMENTS:_uIe" or b <br /> ACCOUNTING ONLY. FACO <br /> AID# <br /> PE CODE FEE INFO AMOUNT AIMITED RMOVED By DATE an I KIM=NUMBER "MICE 0 <br /> A5D %,Q <br /> ACCOUNTING ONLY:11 <br /> Pub.Hearth Serv.-E nviro.174(31N) <br />