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SAN JOADUIN COUNTY PURUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBE,R'AVENUE,STOCKTON,CA 95201.388 <br /> (208)468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRE$1 YEARFROM DATE ISSUED <br /> APRICATN)N IS NEPEBY MADE To THE BAN JOAQUIN COUNTY FOR A PERMIT Toe Icam <br /> OeIcam RUCtik T In TA)ftstTAEj THE WOO(pEecRIBED TING <br /> JOAOUN CDUN'E1•DEVELOPMENT TitUE,CHAPTER 9-111 OLS AND THE STANOAPOI OF BAN-JOAOM COUNryFtfflX NFALEN*EI WA6F1f. W~AL HEALTH gdMK WITH SM <br /> JOB AomsslOn mwo <br /> OWNER'S NAME .i.I'� i/( A ORE94 <br /> couTRACTDR_.C�G.'T.lea/�I',� i"7Jv✓fO/�` �. .r,...,SA �R'�+'�i�.���rqD► �"I '�' !f/ <br /> SUBCONTRACTOR ADOR-1 UCt PTIOt!' <br /> TYPE OF Of"IC WORR: NEW NMT ALLAl10N❑ BNfIWADINTIO `j OESTRLICTION❑ <br /> 010 6EPi1C 6YETEM PERIIITTEC IF PllSllc 6ELVEq Is AVARAPI.E YA/MIN 7M FEFT OF RIALU— PPTC TFATIN I 1 NOW MANY <br /> APPAmtlaA t <br /> INSTALLATION INILL SERVE RESIDEN(;Q& COMMERCIAL Q UTfIER Q <br /> NUNIVER OP LINING UNITS: NUMEU.SOF BEDROOMS. L' - NL.MR6 OF—PLOYEEt:_ <br /> CHARACTER CF SOIL TO A77�OEPP''TH�H OF-3I FEF7 gT,NUMP SDl1 CHARACTER--WATER TA&E DEPTH <br /> O ' <br /> iEII1C TANKlOREAS(TRAP TYPEIMFG CAPACITY_ NO_COMPARTMENT? <br /> PKO TREATMENT PLANT Q INSTANCE TO NE'A14lT. WEU. FOUNDATION PROPERTY UNE <br /> UFT STATION D suf TYPE O_F�FVMP_��, �, OR SFPARATOR IENCI OSF <br /> LEACNNUNE A+NLONESDISTANCE TO WAFIEDST9:YWTLELMI <br /> 1, FOUNDATION_:�'/ FN,EINE <br /> FILTER B® 13 O0 <br /> _IENC.TH OE/TX pSTANCE TO NF'ARF.RT:WElli_4&;$FE2'F'OUNDATIJN ►WPEA'TY LINE,_ <br /> MOUNDED ❑WIDTH LENGTH_ _DEPTH DISTAMCE TO NFAIEsT;WELL FOUNDAMN PFIOFERTYLS¢ <br /> iFEPAOE PUTT ❑DET+THBIZE��NUMBER.DISTANCE TO NEAREBTt WELL �F0UNOATION _PIEDPE'KTY UNE <br /> AL <br /> IMPS 11 WIDTH I..,mN�a'�oERX 19 DISTANCE TO NEARESTI YIEEl;_f,(tom FOUNDATION a 0 PMPEPMV_:i= <br /> DISPOSAL DONDE 13 WIDTHIENOTIE DEPTH DI6TANCETONEAREMT:WELL FOIRJDATION PFOPFPTYLINF <br /> YIp�t�•A� <br /> 1 HEREBY CERTIFY THAT 1 HAVE PPfvAREO NtB APPICATgry AND TNFT THE WOR,NSLL OF FOW IN ACCORDANCE wITN MAN JOAOLRN COUNTY OROIHANCES AND STATE UWM,ANDRULES <br /> ANDF ERMYr 98IS OFTMESANJOAOVMCOYMY,MOMSOWN ER OR UCtT'18ED AOEM'B SIGNATURE CERF1FfES THEMLLOWINO;'1 CERTIFY THAT IN THEPERFORMANCE OF THEWOW FORVA1CH <br /> THOS PERA.VT 18 t16UED,i SMALL NOT EMPLOY ANY PERSON IN SU1CM MANNER AS TO BECOME WBJECT TO WO0(MAN'8 COMPENSATION LAWS OF CALIFORNIA.• CONTRACTOR'S FMONO OR <br /> SUB-CONFRACTWq SIGNATURE CtYGBHFe THE FOUL tY1MN C TMATAN INT R"I RMANCE OT 1MF`AoF4(FOR WHICH THIS PfKMFT IB IBSUM,1 WALL EMPLOY PERSONS SUBJECT TO <br /> WOFEUMAN's COM MATION LAWS OF CAUFOg1IA.• ANT M 'CALL 14 MOUS IN ADVANCE FOR ALL RE ED I, PECTIONS, COMPLETE DRAWING BBEELOW, <br /> / / lam O' r,�+N (✓�I•"]-F,I^// �� <br /> SIONEDX f /�'/- 1./ ✓ ESTE: <br /> PLOT RAN W TO ,SCALE <br /> 1. <br /> OUTLINE OF THE PROPERTY,WITH DIMUMONS ANO NORTH MRECTION. <br /> NARES OF STREETS OR nOAOD NEAREST TO CR BOUNCING TH PERTY 1e4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. EXPANSION OF OEiNAOE DISPOSAL MVMTEM S. <br /> ].OIMENSKINED OUTI.NCS ANO LOCATION OF ALL EXIMFINO AND PROPOSED STFWCl UREn- B.LOCATION OF WILLS WITHIN RADIUS oP ONE HUNDRED FIFTY FT,ON (1 <br /> INCLUDING <br /> WE AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALY,6. THE PROPEKTYOR ADJOINING POPEATv <br /> X <br /> �' ,. � Q <br /> rr8 } i9y <br /> 1 FOR DEPARTMENT USE ONLY <br /> APR,ICATRON ACCEPTED BY__ L,,,. G�77Y-�/` _DATE: -7 \ AREA: i Q <br /> TAM(,PT OR SUMP SISPECI'+O11 BY DATE / / f If1AL INSPECTION SY --`_OAi'E <br /> ADDITIONAL COMMENTX: <br /> ACCOVNTNO ONLY; AIUtFACt --�� <br /> PE CODE FEE INFO AMOUNT REM ITER CUECKf ADH RECOVER sY DATE OR f POVAT NUMBER INVOICE P <br /> 4Z- <br /> Pat),Msalth Serv.-Envjr 174{3196) <br />