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APPLICATION FOR 1.1010 WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION �(� u 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468.3420 RON•REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICIIaPb11 M TrIDIYItMI APVUCATNIN IM HEREBY MADE TO THE MAN JOAQUIN COUNTY FOR A PERMIT TO CONWAUCT ANDIDR INSTALL THE WORK DESCPBED. THIS APPLICATION POMADE IN COMPLIANCE WITH CAN JOAQUIN COUNTY OEVROP'MENT TREE,CHAPTER 9-1111/0.9 AHA THE LIC STANDARDS OP SAN JOAOURN COUNTY PUBHEALTH SERVICER.FMARONPAEMIN AL HEALTH VISIOH.I.Dpb#2.- 1.30 A OI me AOEBBIOn Awe 08/-/00-17 106 61 E. H vy,4. ZG CITY S�oU`t-t1JT� LOT�ILE ��l\past„ owNEnY PMI.TE �RTtSI,-,6&\,�N7N e.-V-ADaEEse 1.3325 E 26.Sto cktnYl. 6A 2G�/.5 CONTRACTOR o w Y1Cr ADDRESS Se-mG 0-'> Q�DoV C LIC. FMNE we CONTI4CTOR ADDRESS pIFTI MR PIOHF TYPE Cf some WORK: NEW IMBTALUATION❑ REPAINAODMOM pI tKSTRUCTIOM❑ M OEM.SYSTEM PEM ITTED IF PVBUC SEWEM IB AVARABLE NTTHIN 200 FEET OF BUMLINNO.I —TO11H I 1 HOW MANY MM,,�W APPMw4N F INSTALLATION WILL SERVE: 11ESIDENCE 19 COMMERCIAL 13OTHER 13Mt MVaI of LIVINGISSTI: I MMMM IR Of BEDROOMS: 5 NAl.V11111 OF EMPLOYEES: CHARACTER OF SD1L TO A DEPTH OF 3 FEET: C j&! FIVO NIP 80l CHARACTER' G\0'�/ WATER TABLE0 r SEPTIC TANIUOEASF TRAP Kj TYPEAIFO GO Nf_r•G�1L CAPACITY V20 D �O�\\oh 5 NO.COMPARTMENTS PILO TREATMENT PUNT❑ tPISTAMCF TO MEANEST. WELL FOUNDATION PROFERTY LINE O LWT STATION❑ RLE TYPE OF PUMP SAND OIL SEPARATOR LFNCLOEED SYSTEM �+OO//TT /F, tuLIMNo MME IA NO,B LENGTH OF LIMES X DISTANCE TO NEAPESFI WELL DATIONrourl JAI/ PROPERTY LINE 10f A FILTER MID ❑WROTH LENGTH DEPTH DISTANCETO NEAREST:WELLFOUNDATION PROPERTY LINE MOLMIOED ❑WIDTH LENOTN DEPTH DISTANCE TO MEANEST:WELL FOUNDATION PROMPITY LE --F— T INT "WAGE INTO DEPTH ZS—MZE3G NUMIEn L.y DKTAMLIE TO NEAREST:WFu�T FOUNDATION 70 pPDPFRTYUNE 25 scars ❑WIDTH LRNGTH OWTH DISTANCE TO NEMIEBT:WELL_FOUNDATION PROMRTY UNE DOMOMAt.PONDS ❑MRDTH LENGTH Off" DISTANCE TO MEANEST:WELL_FOUNDATION PROPERTY LINE I HEREBY CEITRY THAT 1 HAVE NEPAREO THIS APPLICATION AND THAT THE WORK VALL BE DONE IN ACCORDANCE WITH SIN JOAQUIN COV—ORDINANCES AND RATE LAWS,AND RULED AM01[OLPLATOM OP THE SAN JOAOUN COUPRY.NOME OWNER ON LICENSED AOEMMO NATURE NATURE CEMiIES THE fOUDWINO:I CIEN IFYTHAT IN THE fOM fO/ ANCE OFTE N4IK FOR WHICH TMS PERAIT N ISSUED,I SHALL NOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO NV RKLAIN'S COMPD MATIOFON LAWS Of CAU "&' CONTMACTOR'S NNBNO CR ws-CONTRACTIMO MIGNATURE CERTIFIES THE FOLLOWING:I CERTIFY THAT IN THE PEISORMANCE OF THE WWOM FDR WHICH THIS PEMtT H 18811ED•I SMALL EMPLOY PERSONS SUBJECT TO C INDWMIAN7 COMPENIATDN LAWS OF CALIFORNIA.- THEAHP"mANT MUST CALL 24 NOV"IN ADVANCE PON ALL REMAINED WME)CMINS, COMPLETE DRAWING BELOW. Q b V SIGNED X ��'AN�.ISJ TITLE: O�'T\�IC DATE: /Z 717 q N PLOT RAN(DRAW TO SCALER SCALE 1.NAMES Of sTRECTf On/ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE$[WAGE DISPOSAL SYSTEM ON PROPOSED 2.OUTLINE Of THE PIOPEIITY,WITH DIMENSIONS AND NORTH DEFECTION. EXPANSION OF SEWAGE EMOMMAL SYSTELS. 0. DAENSIONEO OUTLINES AND LOCATION Of ALL EXIBTING AND PROPOSED STRUCTURES. i,LOCATION OF WELLS WREN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAB SUCH A8 PATIOS,ORI111WAY8.AND WALKS. THE PROPERTY OR ADIOINEIG PROPERTY. _. .. .. .. .__. .. .: . ::. 1: .__. ....... _. 1........ ... ... :.. :. ... .. :... w ; 6 Pim PP �� z1kelS L ...... r�r .... ...... .-,. t .� ..i.... .._. .. ._. - SY �i7.A5L . _. . , ...: ..,.......... bG._ye............ . .. ...� - I 691 • ...�k .;2/Q._' .... t..... : .... POM—A11YMtlIT Lm ONLY -7 Sl APPLICATION ACCEPFED BY 'J DATE: AEEA' Y T P MIiFCTKNI DY DAiE /L/ FINAL INSPECTION 6 DATFOM _�Y ADDITIONAL COMMENTS: ACCOUIIRMO ONIr: AMTA FAC+ p CODS TB INTO AMOUNT RSM ITED cREC AAH NECETVF-MY DATE an r PaMT IEMEm INVOICE �� 1` Pub.HPBIih Sere.-ERYm 174(3/'28)