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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 988,304 EAST WEBER'AVENUE,STOCKTON,CA 96201388 (109)4118.3420 NOR•REFURDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (CtnPiETE In TrbRan) APPLICATION IS HEREBY MADE TO THE BAN JOAOUN COUNTY MR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WONL DESCRIBED.THIS APPUCATION It MADE IN COMPLIANCE WITH BAN ,L JOAOUIN COU'rY DEVELOPMENNTT TITI/F.CCHAFF04 0.11100.3AND THE tTANDMO9 OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,EINBRONMENTAL HEALTH DINBIDN.jo+ /2- /•3y�O�l,C,y� JOBADDKSBKIR►AVPPNE CPgq-/00-/_7,_ 1016091 E.. 1 {�/ 26 /CRY �cysi )6. /,LOTQIr-u 3-as f1p"A•b-4 OWNEWS HAME I l\�C G T 7 MJ"OPS�C•.�� ADDRESS 133Zg �. 14yv`y.2�CI�G�}7� C!7 ATONE AFk CONTRACTOn CAuh�r. ADDRESS SA"MC- 0.5 QJOdV�. LRC/ PHONE SUB CONTRACTOR ADORESS UCI RHONE TYPE OF 40MC WOML• NEW INSTALLATION❑ P"AIRfADDITIONic DESTRUCTION❑ .M SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 100 FELT OF BUILDING.) PRC TEST(.)I 1 NOW MANY 1 ApBsSen IFINSTALLATION WILL SERVE RESIDENCE 19 COMMERCIAL 13OTHER❑ NLASSER OF"100 UMTS:_NUMBER OF BEDROOMS: _NUMBER OF EMPLOY®: '7 CHARACTER OF SOIL TO A DEPTH Of 37 FEET: G\Qy PTT/BUMP SOIL CHARACTER_C" ... WATER TABLE DEPTH SEPTIC TANK/GREASE TRAP 19 TYPUMFO L�I'StS RLq CO TLC,7'p kG CAP. 120 54.kjO Y, NO.COMPARTMENTS Z FED TREAIMEIT PLANT❑ DISTANCE 70 NEAREST: WE{.I. FOUNDATION PROPERTY UNE LFT STATION❑RRStST B :3IZE TYPE OF PUMP/ BAND OIL SEPARATOR(ENCLOSED SYSTEM( 01 / LEACHING LINE NO. LENGTH OF UVEB X 4O DISTANCE TO NEAREBT:WTLL$�FOUNDATION PROPERTY LINE IP� FILTER SED ❑WIDTH LENGTH DEPTH DISTANCE TO NENEST:WELL FOUNDATION PROPERTY LINE L40UNOW ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE SEEPAGE FRIG I1�T OEPTH 7T SIZE -5�NUMDEA�_DISTANCE TO NEAREST:W[U_FOUNDATION 100 O PRPERTU Y NE G 5�• SUMrB 113-,WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS I..I WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION P110FERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL SE DONE IN ACCORDANCE WTIH SAN JOAOUN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND IEOUCATIONt OF THE MH JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S EGHATUIE CERTIFIES THE FOLLOW IFIM'I CERTFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PENMfT IS ISSUED,I SMALL NOT EMPLOY ANY PERSON IN NCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S S COMPENSATION LAWOf CAUWRNLA w CONTRACTORY HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE Nf019K FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERO"SUBJECT TO WORIWAN'S COMPENSATION LAWS OF CALIFORNIA.* THE APPLICANT MUST CALL H HOURS IN ADVANCE FOR ALL IMMURED DfAM CTIONt. COMPLETE DRAWING BELOW. n BONED X �O1S TITLE: DATE: i f f•.3 7 R PLOT PLAT!(DRAW TO SCALE SCALE_'m T.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 1.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3.DIMENSIONED OUTLINES AND LOCATION Of ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION Of WE"WITHIN RADIUS OF ONE HUMPED FIFTY FT.ON INCLUDING COVERED MEAS SUCM AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. ..... ....... .... ....>.... .... .. . .. . .. .. lcicet.lT+Wcs 9'.9.. �a�W...... L .... 1� St1T4i� I .....:... ....... .. $''''...;......T .....,... .. . ... ....... .... .. .. '.. . . etF ... .......... .. _. e r'x1 cZ. �1T.. .. u t . 41Yv?ap £fyH L _._ .._. .. ..... ... gl ..-E.. I�t�rll.. Z�, a.. FOR DEPARTMENT USE ONLY p Q APPLICATION ACCEPTED BY C DATE: �+ f Q AREA: z r TANK,PIT OR SUMP INBPLCTOfI BY DATE I I FINAL LHSKCT PON BY ADDRONAL COMATETTS: fft4 NLY: /VDI FAC/ FEE INFO AMOIMT REMITTED CHECK/ H RELEVEO BY GATE mf PEP.BT RU m INVCICt! 1any z� 8 5 Pub.Health IS—-Envlro.174(3108) .J