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SAN JOAOUIN COUNTY PUBLIC HEALTH SEP "ES <br /> ENVIRONMENTAL HEALTH DIVISION `BB/ <br /> P.O. BOX 3M 304 EAST WEBER AVENUE, STOCKTON, CA 95201.388 <br /> 12091 465-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (ComPlsn In TrIplkoh) <br /> APPLICATION IS HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRICT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLCAT GN 18 MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8-111,0{.33 AND THE STANDARDS 0 SAN JOAO/VINoCOUNTY PUBIJC HEALTH SSERRRVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDREBBIOR A/�Rlt�/ OL �/ - �/"1 a /'� �^ p'T /�� /CIN/'ln'"u(}�,A�A�E� LOT SIZE( "'Id ( <br /> OWNER'S NAME ^-LJJ//-4 JL�L+1�d SdV,'g ADDRESS /�1�,nI toDd K�L.E P�'IQ/ 7�J 1�� FHRR <br /> CONTRACTOR A'�'l �i J1��1 L -ADDRESS/2-1 CA ( � // UCI LZ�RIONE -/Co3-S 3�' <br /> SUB CONTRACTOR ADDRESS LIC# PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIRIADMTION ❑ DESTRUCTION❑ <br /> (NO SEPTIC SYSTEM PERMITTEE IF PUBLIC SEWER 19 AVAILARI E WITHIN 200 Ff ET OF BUILDING.) <br /> PFRC TESTI)I 1 HOW MANY <br /> APPllanaen t <br /> INSTALLATION WILL SERVE: RESIDENCE EVCOMMERCIAL ❑ OTHER ❑ y/��{ <br /> OF LIVING UNITS: / <br /> BER <br /> OF <br /> C <br /> NUMBER <br /> ER OF SOIL TO A DEPTH OF O FEET' OF BE/d�100M8: (BUMP SOIL <br /> -O 1C�HAMCTE�OR ,5'n, WATER TABLE DEPTH V�' 4- <br /> PICT KJOREASE TRAP ❑TVPE/MPO K- HU CAPACITY�� NO.COMPARTMEN�T.BeL�f� <br /> PKU TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL POUNDATON /IQ ' PROR:RTY UNE.I..Td.c_ <br /> UFT STATION E3 SjSIBE_ TYK OF]PUMP�SAND OIL SEPARATOR(ENCLOSED SYSTEMI'�� E ' <br /> LEACHING UNE )L..T NO.A LENGTH OF UNEeYJa-�00'X f/1 DISTANCE TO NEAREST:WELL1-��FOUNDATIONS PROPERTY UNE <br /> FILTER SED /❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION F OPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL �.�'1 FOUNDATION PROPERTY UNE <br /> SEEPAGE RTS {y DEPTH 7S. , Mm I' ZJI NUMBER DISTANCE TO NEAREST:WELD_FOUNDATION PROPERTY LINE <br /> BUMPS E WDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL POND8 ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APCH <br /> PICATION AND AT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> AND REODUTIONB OF ESANJOAOUIN COUNTY.NOME OWNER LENSED AGENT'S SIGNATURE CERTIFIER THE FOLLOWING: THAT IN THE PERFORMANCE WORK FORING OR <br /> THIS PERMIT 18186. .I ALL NOT EM NY PERSON IN BU H MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HI <br /> RNG OR <br /> SUB CONTRACTING SIGNA U CE iIFIEO HE LLOWINO:'1 C THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATI N W9 IFOR IA.' WT FALL 34 HOURS IN ADVANCE FOR ALL REG ED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> A �/ <br /> SIGNED XTITLE: 6� DATE: / _ /� <br /> PLOT PLAN(DRAW TO SCALES SCALE 'F- <br /> 1. <br /> 1. NAMES OF STREETS OR ROADS HE O OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY.NAT"DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED 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 PATIOS,DRIVEWAYS,AND WALKS. THE PROPEWY OR ADJOINING PROPERTY. <br /> SFCJLILJ \\\\\\ <br /> 00 <br /> L <br /> J <br /> T <br /> LUL2�m <br /> ra <br /> � A r.12LL -moo <br /> FOR DEPARTMENT USE ONLY <br /> HATE' AREA: Z/ <br />