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2004 - <br />521 <br />FT.5 — SAN JOAQUIN COUNTY PURLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201-388 <br />(209) 4SIT342D <br />PICHITREFUADARE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />ISAMIT1016 In TrReam) APPucAmon LO NERIEBy MADE <br />10 THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONS/AucT ANTLOR iNsTALL TIE WOW OCEL:RISED.1144 APPDOATion is MADE IN COMPUANCE <br />IMErl MAN JOADUIN COUNTY DEVELOPMENT RILE, CHAPTER 5-1110.3 AND THE STANDARDS OF SAN JOAOLON COUNTY MEEK HEALTH SERVICES. ENVIRONMENTAL HEALTH DIVISION. <br />CITY LOT <br />C-2?- InIONE R —4'1'2 7 <br /> UCH PROW <br />—.......—_- <br />TYPE OF SEPTIC WORK: taw Mai ALLATIoN 0 ousAirvAnD,RooldT., DesTRucTiao 0 <br />WO SEPEIC SYSTEM PERMITTED IF PlAiliC SEWER is AvArLArit No EKE/ 700 !EFT OF MIXE011,11.1 <br />INsTALLATION WILL SEnvL 0ESIDEN4t. COMMERCIAL CI OTHER 0 <br />NUMIER Of ENING MTh: ...1 Nissans OF IIEDROOMA: -1......"- AIRLINER OF !WROTH.. <br />CHARACTER OF SOIL TO A DEPTH OF S FEFT,S7‘..-•"Eni PlusLINIP sari CHARACTER WATER TABLE OEPTH y ••-•,- -- <br />,...„---.)/7 ---' <br />SEPTIC TANKtOPITASE TRAP EITYPESSFO CAPACITY No_ COMPARTMENTS <br />POCO TREATMENT PLANT 0 DISTANCE To NEOUTE•21, T• WELL FOUNDATION PROPERTY UNE <br />tin. STATION 0 SI2E TYPE a/ PINAR sAND Ds SFPARAMR IF.NCI OEFD SyST EMI <br />LEACRINO WET <br />FILTER OFD <br />I& 110. 4.11 10 soF LINES ,...t..".4— 5//), , 016105CE TO NLAFIEST: WE1L2 (....) FOUNT/AMP/ il/ROFERTY URN ...2.--C—:) 1 0 WIDTH '' I ENOTI1_,„ablie„„ CErT1-1_4rak DIE TANcE TO NEAREST: WE ,A-P PROPERTY motroDEO 0 woliq - . LENOTH ofvEN DISTANCE To NEAREST; WELL FOUNDATION PROPERTY IOW leosikoE SITI1 (3 sizE 7 NUmBER oral-ANTE To NEAREST: WELL FOUN.DATION PROPERTY UNE IUMps LE 0 WIDTH X-, NoTH .2 Z-2 ovon0 ..1.44.' DISTANCE TO NEAREST! WILL -Z.LZO FOUROAT701,1 "::: 1.) PROPERTY L04W'Z' 1.)1 <br />, 1. <br />DISPONAL Poolta 0 MOTH <br /> <br />2... 'LE,E767')C ' SILSAieDEPT5 <br /> DISTANCE ID NEAREST: WELL ',WS/DATION PROPERTY 11(1 <br />I I <br />I HERESY CURIE,' THAT I HAVE pREPAREDNIS APPLICATION AND THF'r 'ME WORK WILL OF now IN ACCORDANCE WITH RAN .10AOLAN COUNTY ORDINANCE. AND EITATE LAWS, ANO RULES <br />( <br />ANS/ SEGALLAncdos OF TME SAN JOAQUIN COUNTY, HOME CANNER OR UcENSED AGETT's seGNATUREcERralEs THE FOU.owiNO: 1 CERTIFY THAT IN THE PERFoRmANcE OF THE WOW ForiSMOCN TIEN PERMIT IS II/540, I SHALL NOT EMPLOY AMY PERSON IN SUCH MANNER AS TO imcciELE SUBJECT TO WOWMAN's oblAWNSAITON LAWS OF CALIFORNIA_• CONTRACTOR'S wRisso DR SUB-CONTRACTN6 SIONATuRE CEARREITHE Fou C THATAN 11* PERFoRmANcE OTTSE WORK FOR WI-NCH TI-18 PEWIT is ISSUED. I SMALL EMPLOY PERKINS SUBJECT TO WoFILMANTI COMEWNSATION LAWO OF CAufORNIA.• ART IN • CALL 24 FOURS IN ADVANCE FOR ALL RE,RED I. FEEcT1ON S. COMPLETE ORAWINO DEL,OW. <br />DATE <br />JOB ADDRESSIOR AHNS 5--C1fe) A1 <br />OWNER'S NANIE_4‹c2q 1f ADOWS% <br />cesankerom e:474-7-1;.L 5fe/A, ofePf" <br />We CONTRACTOR ADORESS <br />Foss TESSIN I I HOW MANY <br />Avallastlx. S <br />IDONEO x TITLE (.> <br />PLOT PLAn vr To OJO, (YALE <br />1. NAMES OF STREETS OR nom,. NEAREST TO OR BOUNDING EL Wray <br />2, OUTLINE OF THE PROFERTY, ERMENEsoNS AND NORTH CW/EcTioN <br />3. oiMENCEONED ouTLINEs AND 1.0001105 OF ALL EroisTIN0 AND MOROSE!) STRLICTURES. <br />INCLUDING cOVENED AREAS strcH Aa RAMA ORDENATS. ANO 000(6 <br />A LOCATION of NOUSE SEWAGE DISPOSAL SySTEM DR FOOPOSETI <br />EXPANSION OF BEWADE OX9FOSAL SYSTEMS. <br />A. LOCATION OF WELLS NERTHIN /LAMS OF ONE RUMORED FIFTY FT. ON <br />THE FROpEnly OR 00)00454 PROPERTY. <br />/./;2-4.4-1 L- <br />„ <br />rd /A1(611-:'' <br />fel, • r ,'•-•7,. <br />t- 5 i9gt <br />V.124 ::.:14M N <br />FOR DEPARTMENT DAE ONE, <br /> --- <br />TOWS, PIT Orli suMF /NSPCC DON ay CATF I I FINAL INSPECTION <br />ADDITIONAL COMMENTS: <br />z- I <br />cval z ,// lq7 <br />APPLICATION AcCLWE0 BY <br /> C. DATE <br />ACC OuNt o ONLY: 1 ADO FACE <br />P55005 FEE INFO AMOUNT %EMI I TED CFIECKS ASIA FICCAVED MX DATE SRI PORES MEMBER INVOICE I <br />C' If i r? 0 i 4 2-1 L-11) 4s/ .... ii <br />Pu0. HeLaSh Seri, Enviro. 174 (3,46)