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112,2221111111 AIDA FACE DATE CIMC 142-i NNOLINT REMITTED CE PEE INTO 0 FOR DEPARTMENT USE ONLY DATE / / 2-pt , AREA: 7 I 15 DATE f ) APPUCA ACCEPTED BY TANK, OR SUMP INSPECTION BY Al' COMMENTS: DATE: FINAL INSPECTION ST PAWN NuMsER MIA=111 I- I- Mliv INVOICES Pub Heattri Serv. - Envku. 174 (3/96) RELN.Y.NITSTOIsIR MEW: r.'Ptf.'7/71• -ç ,1 4 Th 1'7 • Li 1. Ice - - 5 1997 AN 4.1841C HEALTH'SERVICE - :NV.(R.0 S _ ... ...... PESO TEENTI I I HOW MANY APPlost an SAN JCIAOUIN COUNTY PURIM HEALTH SERVICES Doo7 8.6 ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER 'AVENUE, STOCKTON, CA 9S201--388 (20g, 482-3420 NON-Mt021022LE PEWIT XPIFIES I YEAR FROM DATE ISSUED cooRR,erf 9 p Jc7 4if,L6 73345 OWNER'S NAME R. + St-lk s , ADDRESS (are 4 ) k .r1"4- 6"1" P14031E 3S.- a ce JOB ADDRESSOR AMP 7c3:-.) 5 qe,g) c:Z LT) C.? errl. I, 76 V>P LOT SIZE JOAOMN COUNTY DEVELOPMENT TITUE, CHAPTERS-V/10.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION, APPLICATION IS IMAM MADE TO THE SAN JOAQUIN COUNTY FOR A PEANUT TO CONSTRUCT AND/OR INSTALL THE WORK IMSCRISED. THIS APPLICATION IS MADE IN COMPUANCE WEIN SAN (Comptes Is Triplicate SUE CONTRACTOR ADDRESS LC* PHONE TYPE CV SEPTIC WORE/ NEW vASTAuATION 0 REPARJA0ENTION DESTIRUCTIOTI ISO SEPtic SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BURMAN! INSTALLATION WILL SERVS: RESIDENCE COMMERCIAL 0 OTHER 0 NUMBER OF MANG UNITS, 1 NUTATER OF REOROOMS• 3 NUTABER OF EMPLOYEES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: 5 all qj FIT/SUMP SOIL CFLAAACTEIE WATER TAME DEPTH cA7C7 SEPTIC TAMOOPLEME TRAP 0 TYPE/MFG CAPACITY PRO TREATMENT PLANT 0 DISTANCE TO NEAREST. WELL FOUNDATION INT STATION 0 SIZE rift OF PUMP SANILLIS SEPARATOR FENCIDSED SYSTEMT LEACHING UNE DISTANCE ,...., ' „..... ..., 12( No. a LENOT II Of LINES Oil A O i' FILTDI NED To NEAREST: WELL CO FOUNDATION /14, . PROPERTY UHF ts.2I-J ATIO.Im'''' ' ISAIGNA.J.4.2 DEPTH 4fIl'''. DISTANCE TO NEATEST, WELL....6 ..._ FOUNDATION NaiRs.. PROPERTY UNE_______ gammon. 0 WIDTH LENGTH DEATH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE 4TEPAIN PITS 0 DEPTH SCE WAWA INSTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE 0 'MOTH 0 LENGT- I'......-1-- DEPTH_ WT. DISTANCE TO NEAREST: WELL IV r) FOUNDATION (.1. CT ' PROPERD‘ LINE 2v ' SUMPS ___7__. --,7 DISPOSAL PONDS 0 WIDTH LENGTH DEPTH , DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UHF g'ote..-,, (if-1) tV5 .-3) I NEW O BY COMFY THAT I HAVE PREPAFIDITTWAKCUCAN9grASISet AK 14 DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS, AND RULESAND ITERIXATION6 OR THE SAN JOAQUIN COUNTY. NOME OWNER OR CEASED AGENt NSIGNATIWIE CERTIFIES THE FOLLOWING: 'I CERTNYTHAT IN THE PERFOMIANcE OF THE VANN FORWFITcH THIS PERMIT IN ISSUED, I INNS/I. NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WONKIAAA'S COMPENSATION TAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUISCONTRACONO SIC/NATURE ,t1q1 PIES THE FOLLOWIN • 'I CERTIFY TNAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAIRO ANT MUST CALL 24 HOURS 04 ADVANCE FON AU. RECTUIRED INAPECTONS. COMPLETE ORAIMNQ BELOW, TITLE: (I. e-) DATE, DRAW 'TO SCALEI SCALE 3, DIMENSIONED OUTLINES AND LOCATION OF MI. EXISTING AND PROPOSED STRUCTURES 1 NAMES DIF STREETS OR ROADS NEAREST TO OR SgTiNaIG THE PAOPERTY, 2. OUTUNE Of THE PROPERTY. WITH DIMENSIONS AND NORTH DIRECTION. i01111111111111111=Mwaira: INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNORM FIFTY FT. ON 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED THE PROPERTY OR ADJOINING PNOPERTY. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. NO. COMPARTIANTS PROPERTY UNE 0