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SAN JPRRUIN COUNTY PUBLIC HEALTH SERVICES <br /> *,,,L{IRUNMENTAL HEALTH DIVISION <br /> P.O. BOX 38K 304 EAST WEBER AVENUE. STOCKT'ON. CA 9STol-w <br /> (209) 468-3420 <br /> SWUM VDABLE PERMIT EXPIRE$ 1 YEAR FROM BATE ISSUED <br /> ICe"bta in Tro ata) <br /> :ATION 18 HEREBY MADE TO THE SAN JOAOLIIN COUNTY FOR A PERMIT TO CONSTRUCT ANOA)A INSTALL THE WONC DE9CRI1IED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN <br /> !IN COUNTY DEVELOPMENT TRLE•CHAPTER 8-11 10,3 AND THE STANDAF"S OF SAN JOACIUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DFVISOH. <br /> OOIIE&910R APNM/_ -cl l� I bCZ.L V,L FSLOT a1ZE j2L_ <br /> R'8 NAME • • �. ADOFREaB .� PHONE 3�g'^ .3o3y <br /> jACTaR <br /> R _�ADDRE68 1 LIC/_- 3as 1a L mt. <br /> ONTRACTORPHONE <br /> 3F SEPTIC WORIL• NEW MTALLATION IIEPIIIIMOOIUON OFiSTNIINCTION❑ <br /> PTTC SYSTEM PERMITTED IF PUBLIC SEWER is AVAJABLE WITHIN 206 FEET OF BUI DNNGJ PEW TFSTW 1 I HOW MANY <br /> AOISaMbn ff <br /> DATION WfM SOWS: IESDENCE CN COMMERCIAL❑ OTHER❑ <br /> NI LIf UVNO UNITS. 1 NLRY®T OF smIMIOM!- .3 NUIWNWq OF BMPLOYMS: <br /> 4CTFR OF SOS TO A DEPTH OF,FEET: � PIJISUW SM CHARACTER: di WV WATER TABLE DEPTH ��D <br /> TANKMNEASE TRAP ❑TYPE&wG CAPACITY NO_COMPARTIMENT8 <br /> REATMENT PLANT❑ DISTANCE TO NEAREST: WELL_ FOUNDATION PnorERTT LINE `If /-+1J ` <br /> LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR IENNCLPBED SYSTEM) ` ) <br /> IND RAVE ® NO.i LENGTH OF LINES DISTANCE TO NEAREST:W!~LL _c>, FOUNDATION, i D PROPERTY UNE�S <br /> LIED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELT FOUNDATION PROPERTY LINE <br /> � 13 WIDTH LENGTH_DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> OE PIT! ®DEPTH, c SRE �NUMBER a DISTANCE TO NFJU1EeT:WELL 420 FOUNDATION- PROPERTY UNE �r <br /> ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> NAL PONOS ❑WKTTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE E <br /> BY CERTIFY THAT I HAVE PREPARED THIS APPLICATION APO THAT THE WORK WILL RE DONE 1N ACCORDANCE WITH SAH JOAOURI COUNTY ORDIIANCES AND STATE LAWS.AND RULES <br /> EGULATIONSOFTHE SAN JOAGUINCOUNTTY.HOME OWNER Oft LICENSED MENVII SIGNATURECERTIFIESTHEFOLLOWM.-'ICLTSTIFYTHATINTHEPERFOIMIAHCEOFTHEWORKFORWHICH O <br /> EFIMIT M MSUED•1 MALL NOT EMPLOY ANY PERSON W SUCH A MANNER AS TO BECOME SUBJECTTO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HWH6 OR <br /> DNTRACTNNG S ONATURE CEI"W9 THE FOLLOWIIQ I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR VOWN THIS PERMIT 19 ISSUED,i SHALL EIAPL.OY PF.IISONS SULLIECT TO <br /> MAWS CCOMPENSA LAW!OF THE APPLICANT MUaT CALL 24 HOUIIS IN ADVANCE FOR ALL REOIlI1ED WHIPIMMON4. CDMi,E'TE DRAWRIO BELOW. <br /> >,x r+^L. mLf: <br /> PLOT PLAN DRAW TO SCALD SCALE 'le <br /> MES OF STRUTS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4_ LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> TUNE OF THE PROPERF.WITH DIS AND NORTH 011RECTIN1. EXPANSION OF SEWAGE OISPOSAL OYSTEIM. <br /> 4ENSIONE6 OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES. S. LOCATION OF WELLS WITHIN RADIUS Of ONE HUNDRED FIFTY FT.ON <br /> LUDIHG COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,IVO WALKS. TGE PROPERTY OR ADJOWW G PROPERTY. <br /> - ✓ �.� –� A <br /> ....... ..... 1...... -. . - - -- --- --- <br /> .:.. - <br /> : . <br /> . <br /> .... ...... <br /> .. . <br /> ... ... <br /> PECEVVED <br /> _ ocr - 21997 <br /> .. .' -... SA- OA{�IJtN C:UUi+i f <br /> N 9 � <br /> ..... .. ... ...... PU3LC-yEALI i SERVICES <br /> - - ti LTH LmvmlON <br />