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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O,BOX 988.904 EAST WEBER AVENUE,STOCKTCM.CA 95201388 (204)462.7420 NON•REFUNOARLE PERMIT EXPIRES 1 TEAR FROM OATS ISSUED rAmll4T.1%TI}DeaW AFPVCATON IS HFAERV MARE TO THE DAN JOAOUIN COUNTY POR A PEFS.ST TO CONSU6KT AND/OR INSTALL THE WOW DEOCRSEED. THIS APPI"t1001 N MADE N COMPLIANCE YAM SAN JOAIODIN COUI IrY OEVELOPMEM TITIL CHAPTER 1-1110A AND THE STANDARDS OF MH JOAN COUNTY PUSUC HEALTH SERMIU.EAAIONMENTAL MALIN OIVIISOM. JOS ADOIESAMR.WIP Uv l'`)•ICJ•.. ip "J. CTf/Lrt-1A=(I4 LOT SIlY OWNER'S MAW- L1ti-wN Sf`YN N3( ADaims. 7 �. / •� )Ik'T PmoNE CONTACTORU eADOIESS UCS PHONE BUS CONTRACTOR ADDRESS UCO PNONF. TYPE OP SEPTIC WORK: NlW IIATALIARGRI.;Ir R.I)DITION❑ Bs4TUCT10N❑ W SEEK SYSTEM RERMITTED IF PUBLIC SEWER IS AVALABLE WITHIN ZOO FEET Of BURORx1.1 PBIC TE1ihV I I HOW MAI/ IAISTA/U TOI N'ILl O61K: NlJlIFM:E COMMER.x OTHER❑ V N111Y1OEA OF{MND—I.; I WAIVER OF SEa100MM: 2- mxAgEm of BNnOYm:J CHARACTER OF SOIL TO A DEPTH Of 7 FEET- PITIGUMP SON CHARACTER: WA7EA TABLE DEPTH 40111E TANK"IEASE TRAP ❑TYPEIAFO -1 AOI_ L— JCAPACITY ;L<0 1/(o On NO,COMPARTMENT* IE EW TATIASNT RANT EJDIITARCE TO NEAMT! WELL 100,'1- •FOUNDATION PPOPERTY UNE LIFT STATION L]�.�BRE TYPE OF Pwp ry� '^ZBA/N,D OR SEPARATOR IENCLOSED BYBTEMI IB LEACPIOMI LINO / NO.S LENGTH OF U �&6;5NEA /"CJI }AES lo, DISTANCE TO NEAREST:WELL FOUNDATION. PROPERTY LIF_ PILTIM SED ❑WIDTH LENGTH_ DEPTH DISTANCE TO NEAREST'WELL FOUNDATION TfOPERTY UNE MOUND® 4 WIDTH LENGTH_ OEPTN DISTANCE To NEAPEST:WELL FOUNDATION PROPENIY LINK OFJDAGE PITO ❑DEPTH—DQE__ QE NUMBER DISTANCE 70 IO NEAREOT:WELL T9UN>ATN PROPERTY UNE _u1 6URMs 11 WIOTM LENGTH_—_DEPTH DISTANCE TO NEAREST:WELL P0IAfMTOH PROPERTY UNE DISPOSAL PONDS PONOS Cl WIDTH LENGTH DEFrN DISTANCE TO NFAIEST:VVRI FOLIHOATOO PROPERTY LINE 1 HERESY C W"I`Y THAT f HAVE PREPARED THIS APPOIATION AND THAT THE M.VVRL M GONE IN ACCORDANCE WITH BAN JOAOLAN COUNTY ORDNANCEs AND STATE LAWS,AND RULER AO IEGDLAmms OF THE BAN IOAOUN COUNTY,NOIRE 0140 R ORLIC'HSEO AODW O SIGNATURE CEW FIRG THE FOLLOWN0:'I CENTIFY THAT NTLI PERFORMANCE OF TILE WOW FOR WHICH THIS PERMIT IS ISSUED.1 SHALL HOT EMPLOY ANY PERSON N SUCH A MANNER AS TO SECOME SUBJECT TO WOMMAWS CCMPENSATION NWS OF CAIFOMUA.- CONTPIACTOFI-6 4MMO OR 6U6CONTRACTINO BONATWIE CERTIFIES THE PoLLOWNG:'I CERTIFY THAT N THE PE FORT ANCE OF TWE WORK FOR Wf*CN TMS PEANUT IS ISSUED.I SHALL EMPLOY PERSONS DUSRECT TO WOIKMAP0 CO AiEl1 TON LAW/S 1NLl' TFE APPLICANT MUST CALL iF FOLFY IN ADVANCE FOR ALL REdARID)Ff6FILTION4. COMPLETE OIIAYIM BELOW. _ONEDx (1 may—' rIr LE:�i•w N'PV� DATE: T PLNI--TO lKALL,-A- 1.NAMED OP STREET/OR ROADS NEAREST TO OR 6C11 .11YO INC PROPERTY. 4.LOCATION OF HOUE SEWAGE DISPOSAL SYSTEM OR PFOPO6ED T.OUTLINEWITH OF THE P"OPIRry. DIMENMONs NNO NORTH ONECTON. Ex Ps1O ANN OF OEWAOE DISPOSAL$*STTM8- J.DIMENSIONED OUTLINES AND LOCATION OF ALL I%16TTNO AND PROPOSED STRUCT111lP. 4. LOCATION OF VIEW WITHIN MORA Of OHF NUINE EO FIFTY FT.ON INCLUDNG COVERED AREAS!LIEN AS MTOS.OfIVEWAYt,ANO WA/K1. THE PROPERTY OR ADIOJMMO PROPERTY, N 1 O wall � VY, Cr- r `Al {o•A1Q�� 'x _ 7 a ®rt. PAY[VIEN7 12 I2 D q-CEI`'F�' fo bo+F D o� p dO.V LAY 15 1997 SAN JUAtH_jIIv uiJI;.'V,+ PUBLIC HEALT'i SFR',II(;Fc .. FOR DEPAIRTMENT LIPS ONLY APPLICATION ACCEPTED BY \ DATE: A9EA: � TANK,PIT OR BLIMP INSPECTION BY DATJ I FINAL INBPECT ION BY D�AI 5-1 1 fl 1-9'-7/1 ADDITIONAL COMMENTS• C-2,1-97LS"`& VICIT � ,�L�LI/CILL� ;¢L Yy/µ(�iiL, ACCOUNTING 0-Y, ADI fACS R COOS FEE IMO AMOUNT REARTIO KO ASN RECEIVED BY DATE IFeFIET MIsl91 INVOICES Vo017 Put).Hedth Sol. Er Q.174(311)(6}