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RAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O, BOX 388~304 EAST WEBER AVENUE, STOCKTON, dX'9520l-W {209) 469-3420 y NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Camplaw In Troucatc) APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPIJA14CE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIOES,ENVIRONMENTAL HEALTH DIVISION. M JOB ADDHESSIO PNi -4p-2 8 CITY LOT SIZE OWNER'S NAME - ADDRESS // p�' / OWL CONTRACTOR �f�Q lj, l Z ADDRESS/Z/ Cha-AC/4 Ll s - ,Ori LIC,�/�� L PHONEVicei 5-14-3 SUB CONTRACTOR ADDRESS LIC/ PHONE TYPE OF SEPTIC WORK: NEW DNSTALLATION ❑ REPAIR/AbbITION Nov DESTRUCTION❑ INO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTIQ( I HOW MANY AppNaetlon i INSTALLATION WILL SERVE: RESIDENCE;VCOMMERCIAL ❑ OTHER 11 NUMBER Of LING UNITE: I NUMBER OF OF BEDROOM/S: ^ NUNMER Of EMPLOYEES: �.. CHARACTER OF SOIL TO A DEPTH OF 3 FEEY. {y ed4V PITISUMP SOIL CHARACTER: WATER TABLE DEPTH ' SEPTIC TANKNOREASE TRAP ❑TYPEIMFO CAPACITY NO.COMPARTMENTS PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE LE=T STATION❑ 81ZE TYPE OF PUMP SAND OI.EARATOR[ENCLOSED SYSTEM) LEACFSIVO UNE n0.k LENGTH OF LINES-/ '�fja! �"rl.� X-Z'aDISTANCE TO NEAREST;WELL FOUNDATION �4 • PROPERTY LINE l L^� ' Q FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL F-OUNDATON PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE PITS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE SUMPS 13WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR ENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICH (j THIS PERMIT IS ISSUED, L NOT PERSON IN SUCRf MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS Of CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CO S NATUR C IFI 8 THE LLDWINO:_I CE 1 THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN' COM N TION SOF ALIFO A.' THE MUST CALL 24 HOURS IN ADVANCE FOR ALL REGURED INSPECTIONS. COMPLETE DRAWING BELOW. �y Y SIGNED X l TITLE: • _DATE; - / y .P4 PLOT PLAN(DRAW TO SCALE)SCALE "to 1. NAMES OF STREETS OR ROAD REST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY.WRTI(�'mtNSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6, LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT-ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. ..... a ASI e� . . 5 yfA }