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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION ` P.O.BOX 398,304 EAST VFBIR AVENUE,STOCKMN,CA 3520/388 L � (20914611-3420 IIOTDREFUNDABLE PERMIT EXPINEB 1-YEAR FROM DATE ISSUED ICORTpletl In T41Gatal APPLICATION 19 HEREBY MADE TO THE SAN JOAO m COUNTY Fon A PERMIT Ta CONSTRUCT AND(OR INSTARL THE WOR(DESCRIBED. TMA APP ICATIO1416 MADE IN COMPLIANCE WITH SAN JOAOIAN COUNTY t)VALOPM�ILEM M�L'E}.CHATTER 81110.3 AND THE SIANDAFtDO OF SAN mAoum cOUNTY FNSLIC HEALTHBE GES.ENYBIa ENFAL HEALTH DIVISION, JOB ADDREGSION AF,,,,?{{{{ll ��/ �.`J ��,/J/ ____ CITY LOT BI]E OWNEITtl NAME� Ll /iY_+7-T 0 CY�ll"l�/7/F APORESe E�/j / CONTRACTDR /Tf AOUREOS ti UCF -ONE T $VB CONTRACTOR ADDREB9 L1CI PHONE TYPE OF SEPTIC WORK: NEW tNNTAL1ATION❑ REPNmAOPITION DEJTRUCTON❑ INO SEPTIC GYSTEM PTR rvTED IF FUNJC SEWER 18 AVNLARLE WITHIN 200 FEET OF BVILUINO.} PER.TESTHI I 1 HOW MARY APdlatlan s WATAILATION WILL aEHVE: RESIDENCE❑ COMMERCIAL❑ OTHER❑ MUMBE R OF LMNO UMTI NU MMPI OF BFMOOMS: NUMBOR OF EMPLOYEES: F CHARACTFR OF SOIL TO A PFPTH DF 3 FEET:_ PITIRU-P SOIL CHAII.CTEIE WATER TA4tLE DEPTH AEPTTC TARKJOR ASE TRAP ❑TYPEIMFO ___CAPACTDY NO.COMPARTMENTS Wo TREATmwrr FLIEN-�T CJ DISTANCE TO NFARU.FAT: WrFOUNDATION P DPEF Y LINE UFT STATION 13 SIZE TYPE OF PUMP - SAND OIL SEPARATOR ENCLOSED SYSTEMI 1 A LEACHHO LENGTH or NO.6 LENGTOF LINEB __{.A URTANCE TO NFAAEST:WELL KL r96 FOUNDATION_PROPERTY LINE /V�! PLTFA SFO ❑WIDTH LENaTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH IENGTH DEPTH DISTANCE TO NFAREBT:WELL FOUNDATION PROPERTY LINE 6UPA0E RTS IMP SIZE NUMBER DISTANCE To NEAREST:WELL FOUNOATFON PFlGFT TY UNE SUMPS ❑WROTH IENOTH DEPTH USSTANCE TO NEAREST:WELL F-0UNDATION PROPERTY LINE_ DISPOITAL PONDS ❑VNDTH LENOTH UEPTH DISTANCE TO NEAREGT;WELL FOUNDAMN PROPERTY LWE 1 HEFEBY CERTIFY THAT 1 NAVE PREPARED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUM COUNFY ORDNANCES AND STATE LAWS,AND RULES r AND REOULATORR OF THE BAN 30AGUINCOUNTY.HOME OWNER ORUCENBEO AGENT'S 813NATURECERTIFIEB THE FOLLOWING:Y CERTIFYTHAT IN THEPERFORMANCE OF THEWOW FORWHKH THIS PERMIT IS ISSUED,I VHALL NOT EMPLOY ANY PERSON W OUCH A MANNER AS TO BECOME SUBJECT TO WOWMAM'S COMPENSATiDN LAWS OF CAI RORMA.' CONTRACTOR'S HIRING OR J\I swe NTRACTINO SIGNATURE CERT IWEO THE FOLLOWINO:'t CERTT}FY THAT IN THE PERFORMANCE OF TILE MMI(FOR WHICH THIS PERMIT IB ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO (� Worm,AN'S COMPENRATION LAWS OF CAUFORMA.- THE APPLICANT MUST CALL 24 NOUS.IN ADVANCE FOR ALL REQUIRED MNAPECTIONB. COMPLETE DMWINO BELOW, LL7�VJlM,\'f`I B,DIJED x� TITLE: 1,��/7 DATE Ilh,) O PLOT PAN IOMW TO SCALEI SCALE 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNCING THE PROPERTYA. LOCATION OF MUSE SEWME INSPOGAL SYSTEM OR PRDPOGED 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAOE DRPOSAL SYSTEMA, 3. DWENSIONED OLITUNES AND LOCATION OF ALL ExISTmo AND PROPOSEo STRUCTURES, S. LOCATION OF WELLS VMH114 RADIUS OF ONE HUNDRED FIFTY FT.ON IJCLUDING COVERED AREAS SUCH AS PATOB,DRIVEWAYS,AND WAULB. THE PROPERTYOII ADJOPONO PROPERTY. .. .. .. v.. : ..... ..... .. o... . ... _ _ ..;.... _..........,.....:......h........ ..........'R bur �D >,.., ......., ....,........., nn J� a pA' .... 1 1999 .... �N�IA�NviN irril I lL71ti. .. .. .. _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE: / IA AREA: TAW,PT OR BUMP mSPEG71017 AY SATE ! FINA+/Ln IN {TION BY LATE r ADOlMMAL COMMENTS: / ` f 2 Q Q Lr 1 IILJOW — ACCOIINTINO ONLY: NO" FAC" "TF-FEE INFO AMOUNT RTMIITEO CIIEOK 1CA6H RECFEVED BT DATE M(►9N,BT NVNR6i INYaICE f Li Pub.Heahh SUrv--EnvirD.174{3196)