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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONIVIEKTAL HEALTH DIVISION P.O. BOX 3K 304 FAST WEBER AVENUE. STOCKTOK CA %Ml -W T, C.�' (2091 469-3420 AOF NOWNEFUNDAKE PERMIT WINES I YEAR FROM DATE ISSUED memples In Tripffello AFRXA,TM It HIWAY OAAOIE TO TW BAN JOAM114 COUNTY s:OR A KFWO TO CGI49TIRUCT ANrI,�O;t WSTAUTHE WOW DIESCRISED. THIS APPLICATION ts MADIE IN COWPUAW-F \wni am JOA4KM COUPrY DEVELOPMENT` TfltF- CHAPTER 0- 1110.3 ANI)TME STANDARDS OF CAN JOAQUIN COUNTY PUBLIC HMTH BM%OlcfD. ENMRONMENTAL 14LOkLTH DrVOW. p -�)51 Wll�,LeW RA 6a 1915-L ti� 99 LOT WE J011 AMORISMI't APNf Li T OVIOP"'SNAW—Cubick ADORF138 Ar Or n pip I c- Jet PHMF-I:s 9,LS I CONTRACTOR 24 9-cl *LABS —Llcl :153(Df-59 Pm-lk-�MS-23JC QDIAV5A V-J�" I( Ampirs S TVi GM COORTIRACTOF�-_ AI)NWSIS tbr) —uC# Tvft Of IlEpm vjtmK; NEW IFINTAILLAMN 0 REPAIPUADIXTION 0 PERC IND GOEPTic SYSTEM PFRmMED IF -UFILtC STWEll IS AVAK-ABLE V%TTHIN 200 Ffrr Or RUILDIM1.1 Tat-tt.1 0WINOW MANY INSTALLAMIN WILL SERVE: M8113FINICE U COMMEMIAL LA OTHER U NPUM86t OF LfVW0 L"TG:_ NUIAGER OF SEDROIOMA;— NumsEm OF DAPLOYM; CHARACTER OF SOIL TO A DEPTH OF 3 FEET PITiSL;MP SOIL CHARACTER: WATER TA8LF DEPT" 013PTIOD TAPAILAGO&A,11 TRAP D tymwa CAPACITY— NO. roupAgrk*NT@ rKel, TIRIATMEPIT M.APIT 11 014TANCIP TO NEAJV�.ST: WELL FOUNDATION! — PROPEIRTY LINE LIFT STAMN Ll SEZC TYPE or Pump SAND OIL sErAfkATOR rENCLOSED SYSTFMI LEACH!"a UNI 11 NO. A LENGTH OF LINER_ Dq8TANCF TO NEAREUT� WELL_ fOUNOAT)0'4_ PROPERTY LINE FILTUR IM Cl WIDTH LENGTH–_ DEPTH DISTANCE TO NEAAEGT� WELL_ FOUMAT!ON- PROPERTY LOW ho"Dw 0 WIDTH LENGTH__ DEPTH DISTANCE TO NEARIEST: WELL— FOUNDATION— PROPERTY ONE RUPA4ff PrTS 0 DEPTH— SQE— -- NUMBER OIUT ANCE TO WAMST: WELL FOLIPIDATION PROPERTY LINE SUM" 0 WIDTH– LENGTH-- DEPT" DrSTANCE TO NEAREST: %TU_ FOUNDATPON- PROPERTY LlINE bfWaGAL PONDS 0 wDTH L.ENCrTH – I)EPTH— DO &TAW E TO NEARE 9T: WELL— �OUINDATION- -I'vK�KIRTY LINE tHEFWGY CERTIFY THAT I HAVE PAEPAAM T"19 APPILOCATION AND THAT THE WOW WK -L BE DONE IN ACCORDANCE VWTH SAN JOAQUIN COUNTY ORDINANCES AND 11TATT LAWS, AND RULES AND MOVILATPONG OFT W BANJO AOUIN COUNTY. WOPAE OWWR OR ILICr"6113 AGIENT'G VnNATURF CERTWIE 0 T14E FOLLOV4WO. 'I C FORTIFY THAT IN THE OF THE WOW FOR V*KH THM PEAKAfT 10 ISSUED, I SHALL NOT EMPLOY ANY Pf`R9ON ON SUCH A WINNE14 AS TO BECOME GU&MCT TO V40FKuAwn C'jMpfNSATpGN LAW* OF CALJFOF"A.* CONTRACTOPI't HIRPRINIO OR OUR-CONTPACTS40 91KINATURE CCRTFIES TIRE FOLLOWING! 'I CERTIFY THlT IN THE PERFORMANCE OF THE WOW FOR WFICH THIS PIEPIOWT 18 ISSUED, I SHALL EMPLOY P01190149 SURACT TO WORKMAN'* COMPINOATION LAWS Of CAL"F#&k' THE A"LICANT PAIJ$l CALL 24 HOURS IN AIDVANCE Pon ALL IREQUPRIED 11161PIOCTPORG. COMPLETT DRAWING IWLOW� SkINED x TITILE: Ll- En tit Q& - 3E -- S�" \- :� -,U r DATE! K)O\) 4m III "RAW TO 5CALV SCALE 1. NAME$ OF 8 TREE. 8 OR ROADS NEAREST TG OR eOUNbvHG THE PROPFWTY. 4. Lue AT" OF HOUSIE SlEWAnF MWOSAI SYSTEM OR PROPOSED 2. OU"I'LINE OF THIE FIROPTIRTY, WITH DIMENIK)"B AND NORTH OIRECMN. FXPANSIION OF SEWAGE 0121POM SYSTEMS. 3. D11IMNSIONIED OVTUNES AND LOCATION OF ALL EXISTING AND PROPOSED 6TFIlLlCfURl,6. S. LOCATION OFWELL9 VVff'l�M RADIUS OF ONIE HUNDRED FIFTY FT. ON MCLUDING CI3VtKD ARE" DUCH AS PATIOS. DWAWAY9, AND WALK@. THIf F"OPFORTY OR AEMINING PROPERTY I N ax JQ 6461 .. . . . ....... NOV 2 0 1998 4 �ANj0AQL)jpj CoUpm' Pusuc RONMFHEA�TM SE�WICEG ILIAI 11EALtH OrV Sl(,,, FOq I)V TPAFwr uti; ONLY 0/0 �l APPLICATION ACCEPTED Gy 12 .1 '? � A.: zn-� -4 —r 0 111 L i4a DATE: TAW, PFT OR VUMP INSPECTP014 BY DAIE I PINAL INSPECTION BY DAVE ADDITIONAL COMMENTS! ACCOUNTING ONLY! I AION FACP FOE Clot)% VtKINFO AmewlymmITE0 clitexa)CASH fwcuvw ev DATE I am I IRMA. NU1,111101 ovulct ff 11400. 2 '�)- C--') 9, 1 C)6,00 �- 1 V, ( A ) i bnnSd /11 -7 le 4,1-� -i Pub Heafth Serv. - Ervviro. 174 (3/96)