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SNEOAQU1N COUNTY PUBLIC HEALTH SERVICES <br /> NVIRONNEENTAL HEALTH DIVISION <br /> P.O.BOX 388;-,4 EAST WF—:BER AVENUE,STOCKTON,CA 95201388 <br /> (209)468-3420 <br /> (� 11WREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUE <br /> 1 k ICamplata in Tt1pmats) <br /> '44„{{� APFVGATgN IS HEREBY i lAhE TO THE BALI JOAoum COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALLTHE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPUA?tCE WITH SAN <br /> JOAGNN COUNTY DEVELOPMENT TITLE,CHAPTER,9-111110.3�AND THE STANNDAROB OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> Jog ADORESSEOR APNI_/// �J fl/!J%L��U �X e-y _ CITY LOT SIZES::j2 - <br /> OM+ 11 NAME ADDRESS �I%� S/S Cf Alld•I� �C EJ —PRONE <br /> coNTRAcroR y <7f/S� AnaREss /}/� �yAk{� UC, PHONE f��1y <br /> SUB CONTRACTOR !1-'L•/��/`L=/L _--AODFSE66 fi3. //Q <br /> TYPE OF*EJ WORK: NEW INSTALLATION REPARVADDITHIN❑ DEATRUCDON❑ <br /> INo SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.] P9W TE&THI l[HOW MANY <br /> L ApglmlLan s <br /> HLSTAWTION WILLaETNE: RESIDENCE I$ COMMERCIAL❑ OTHER❑ �— <br /> NUMBER OF LIVING UMTa; NUMBER OF AEUROO/M^�6: NUMBER OF EMPLOYEES: <br /> CHARACTER OF Son.-to A DEPTH OF 33 FEET: tP 1,I T'ITlSV MP SOIL CHARACTFA: WATER TABLE DEPTH \ \1 <br /> SEPTIC TANKAGREASE TRAP p TYPE/MFO CAPACRY NO.COMPARTMENTB,��^ <br /> PKa TREATMENT PLA1P�-ry1NT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LIFT STATION L.J SIZE TYPE OF PUMP SAND On.SEPARATOR[ENGLOBED SYSTEMI -G <br /> LLACHINO UNE �I NO.S LENGTH OF LINES r3('FYYJ�� DISTANCE TO NEAREST:"TL <br /> C)�PROPERTY UNE sr7� <br /> FILTER BEA ❑WIDTH LEHOTH DEPTH DISTANCE To NEAREST:WELL FOUNDATION PROPERTY LINE . <br /> fiL��II MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPER"UNE Zs <br /> SEEPAOE PIT& ❑DEPTH SIZE NUMBEF DISTANCE TO NEAREST:WFIS!zLrf7OUNDATION PROPERTY UNE.�Y�� rr^S <br /> SLAAPL p WIDTH LENGTH r� DEPTH DI6fANCE TO NEAREST:WELLFDUNDATIaN PROPERTY UNE_ / <br /> �j DISPOSAL PONDS ❑WIDTH LENOTH DEPIH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> !LI 1 NERE&Y CEITT[FY THAT I HAVE PREPARED THIS APPLICATION AND PRAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ANDREGULATIDN9 OF THEBAN JOAUUIN COUNTY.HOME OWNER OR LICENSED AOETN'B SIGNATURE CERTIFIED THE FOLLOWING:'iCENFIFYTHAT INTHE PERFORMANCE OF THEWORL FORWFKH <br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO RFCOME SUBJECT TO WORKMAN'&COMPENSATION LAWS OF CALIFORNIA.-CONTRACTOR'&HIRING OR <br /> SV&CONIRACTkNP SIGNATURECERTIFIES THE F,LLOMTN,S;T CERTIFY THAT INTHE PERFORMANCE OP THE WORK FOR WHICH THIS PERMIT 1&ISSUED,1 SHALL FJAPIOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 34 HOURS M ADVANCE FOR ALL BEOUMED INSPECTIONS.COMPLETE ORAWING BELOW, <br /> SIGNEOX / TRUE• I �17Y��CF.J' DATE„-�,�T / ✓ ` <br /> PLOT PAN IDRAW TO SCALERF SCALE W <br /> 1.NAMES OF STREETS OR 110-3 NEAREST TO OR BOUNDING TIRE PROPERTY. 4.LDCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> Z.OUTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH MRECTION. EXPANSION OF SEWAOE DISPOSAL BYRTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL FXISTIM3 AND PHoP SEO STRUCTURES, 6.LOCATION OF WELLS WITHIN MONS OF 014E HUNDRED FIFTY Fr.ON <br /> PNC UDWO COVERED AREAS SUCH AS PATIOS.DRIVEWAYS.AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. _ <br /> j .t..... ..... .. �"'�' .. ....�. .... - <br /> _. .. .... <br /> Fj .......... :. <br /> � � <br /> ... . ... ....... ......................... ...... <br /> .. <br /> - - <br /> ......... <br /> ........... . . ....... ... ............ <br /> . : .:.... <br /> ....... .. 0 ........... <br /> L <br /> x —< a �r <br /> ..... ... . ............... <br /> ............. <br /> .. ... <br /> 7 <br /> ............. <br /> J..:. ............. <br /> .............. . .... <br /> ... ............ .......... ...................... <br /> : o <br /> ............. <br /> .......... <br /> �..... .............. <br /> ........... <br /> .,.. <br /> ':. .... <br /> .: �< i4 ... ....... <br /> rz <br /> .. <br /> w.......... ...... .......... ......... 1 <br /> ..... . � <br /> ...... ...... . Wiz-- ... ..�sss r:... <br /> x..... u <br /> FN a4ul�cog) rrr <br /> rHbry T s rrj c vrSioN...,,. <br /> ., ...... ....... <br /> N A{.HEAL <br /> +� FOR DEPARTMENT USE ONLY <br /> l APPLICATION ACCEPTED BY t: DATE: AREA: (��J C�J yy <br /> {I TANK,RT OR SUMP INSPECTION BY GATE 1 ! FINAL INSPECTION BY DATE s7 ! / r/U <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AID/ FAC/ <br /> PECODE FEE INFO AMOUNT REMIITLD CHK%J ASH RECTTVED&Y DATE BA TPEMaT NUMS91 INVOICE# <br /> Pub.HBelih Se".-Enviro.174(3196} <br /> F--i <br />