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I SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,304 EAST WE9ERA AVENUE,STOCICTON,CA,95201388 1204) 468.3420 MON REFUNDAW PERMIT EXPIRES I YEAR FROM DATE LSSLt rA,")ota kr TripUclnl APPLICATION IS HERESY MADE TO THE RAN JOAOUIN COUNTY FOR A F'EIT TO CONSTRICT AWODP WRTAM THE WORM OESCMW8 -THIS APRKATIOM IS MADE W COAIPIJANCE T417N UN JOAOUI/COUhTY OEVELOFMENT T^TT�M CHAPTER 8-1110.3 AND THE STANDARDS OF SAN JDAAC"N C(JLW"PISUC HEALTH 99NICEI.ENVRION DOAL HEALTH OIVTBWN. Jon ADDREsIroR Aral (o< < .!!.<- � _ CITY I.or enp��A"'L`"f OWHER'S NAMEiLLl vim. l/�AZ- AODPES6 C.O .A."V— CONTRACTOR_�' Z'O IG O� ILLi ADDRESS X21 C �-�71 S jc, ucP 2Z S A+ONEX/ - 3 SUBCONTRACTOR ADDRE" _LICf PHONE TVPS OP SEPTIC WORK: NEW WSTALLATro B@NRIAOOITION❑ DESTPUCT1011 Q Ol0 SEPTIC BYSTLIJ PEMRTTED IF FVaITC SEWER 19 AVAILABLE VJITHW 2aD FEET OF BIXLDINC,f TEOIC TFSTNI{1 NOW MANY Ir WiTALLAT10H WILL SERVE PESJDENCE) :"L. "[jTNEH II I NINS®c OF lMNO VMTS:�_NISIEYEit OF 6TDROOAAS: -_NVMNTA OF Emp-Loym: CH TEii OF SOIL TDA DEPTH OF 3 FEET,`. PFTICB-OM�P SOI; HARAC 7ER:� �"f" WATE I,—DEPT" 10 ANKMREASE TRAP ❑TYPEfuFG I%c AML S� [4 CAPACIYY ( f' -No.cOMPAATYENrB o? PKG TWAIMM PLANT I] DISTANCE TO NEAMMY WELL FOUNDA110N_�T C P'ROPER''/UNE O /� (OFT STATION d SIQE TYPE 7)F PUMP SANG OIL SEPARATOR IENCI OSED SV:TEM) Q / �\ 11ACNNB UNF )9HO.S LENGTH OF UNE9�"��• ��A�^� D157ANCE TO NEAPF9T:tVELL�_�FOIMOATlO'N�0� NIOPfXIY UNE P11v�y I4 LTF1l S® II WW Tk Lf1JDTH_ DEPTH DISTANCE TO NFAAE9T:WELL _FOUNDATAN PFIOPER'h'LINE MoNNOSD ❑WIDTH LEHGTH__OEPTP DMSTANCF TO NEAREST:WEEI _FOUNDATION PROPERTY LINE AMAM RTS WDEFTH�__9 1�_NVMBER �-' DISTANCE TO NEAREST:WELL,_fOUE�OATIOM PROPERTY LINE SUMPS ❑WgTH LNOTH DEPTH DISTANCE TO NEAREST:WEU___FCONOATTON PROPERTY UNE DISPOSAL PONDS 11 WIDTH LENGTH _DEPTH DISTANCETO NFAAEST:WFll "AlMDATION fE10FERTY LINE I HERESY CERTIFY THAT 1 HAYS RFIARED THIS ANIMATION AND THAT THE WONE WILL BE DON:1N ACCORDANCE VRTH RAN JOAOl9N COUNTY ddJiNANCES AND STATE LAWS,AND NIXES AND AEOUTATIOND OF THE RAN JOAQUIN COUNTY.NOME OWNER ORL.ICENBEO AGENT'S 97WIATURE CERTIFIES TNEFOLLONIHO:'ICERTIFV THAT M THE PEWONJAACE OF THE WOW FVRMlHKH THIS PERMIT IS ISSUED,1 SHALL HOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME IAJS.TECT TO WOWMAN'8 CJNWENSATION LAWS Of CALIFORNIA.-CODWRACTOR'9 KIMM ON SUSrONTRACT910 SIONA ERTIRE THE MLWVM4:'I C W THE PEN`ORMANCE OF TNF WORK FOR WRICH THIS MW11T IS ISSUED.I SHALL EN.Y FE-015 SUBJECT TO WOOKMAN'l 9 ION LA S A.'7H[ T MUST C 24 ILOSIIib IN ADVANCE FOA ALLwAMIED riisvWr 1OIES.CGNINETE ORAWWO BELOW. SIGHTS% _ TITLE: PLOT PIAN IORAW TO SCMEI SCALE 'I. PROPOSED T.HAWS OF STREETS Cl OB IFEAPEST TO OR BO MHO THE PMKRTY. A.LOCATNJN OF HOUSE SEWAGE DISPOSAL SYtTTEM OR NE OUTLINE OF THE PROPERTY.LATH DIMENSIONS AND NORTH DIPECTIOH. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. D.DIMENSIONED OOTUNES AND LOCATION OF ALL E ICTANG AND PROPOSED STRUCTURES. E. WI LOCATION Of WELLS THIN RAONU'W 6 OF ONE HPED FIFTY FT.ON INCLV[INO COVERED AREAB SUCH AS PATIOS,OWVFWAYB,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. • ...... ... .. .. ray. 1:31998: . SAN'jd7444UN COUNTY .P✓BLIC-8EAL.T,4 SEIWICR9 EANtRDNMF?NTA1;HeAL7N.Pflh$y(yy .,... ... FOR DTPARTMLTMT USE ONLY APPPTUC�/A+TIO�IN ACCEPTED BY GATE:- ,�PIT,�R SVM!IN9PECTiON BY DATE f AJC riAL YNSPEC.TION BY7TA, CJ ADDITIONAL COMMENTS' ACCOUNTING ONLY: AIOF FACT •E CODE FDE INFO AMOUNT P—ITm CHECK/ ABN RECEIVED SY OAT! IPERFAT MUm"ImBI INVOICE! Pub.HBB2A 89TY,-E vlm.174(3196)