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SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O.BOX 13M 304 EAST WEBER AVENUE,STOCKMK CA 95201388 <br /> (2051 489•342o <br /> ON•RFFURUR9lE PFRYI7 EYtNxg y R FROM ESTE ISSUED <br /> UCATgN 18 Nk71k7R'MAOF t0 THE SAN JCADUN COUNTY FOR n I•d III TriyKlBtal DATE ISSUED <br /> AIAN COUNTY P'ETILST TO CONSTRUCT ANMR INSTALL THE WORK OE8C15gm.THIS APPUCAr=N IS MADE IN COMFVANCE VMW SAN <br /> DEl�ELOPMENT TITLE CHAPTER 9.9 11100•'.3 AND THE STANOAAG9 CF SAN JOAQVN COUNTY PUEUC HEALTH SERVICES,ENVPLONIAENTAL HEALTH Ory1WON, <br /> ADOREBSIOR APNP_ / //aC <br /> Cm C. LOT B¢E�5G <br /> 4EWS NAME � 14- AD <br /> DRE <br /> TRACTOR PHOS F s�S!/�D <br /> ADDPDPS <br /> �L PHONE <br /> CONTRACTOR ' G�L GL�Q L1C7 <br /> AooREae_���p <br /> ( <br /> OF Ssnt Wmx: NEW INPALLATRSN❑ <br /> neFAPUAoanaN� DyTMX—.,oN❑ <br /> MM SYSTEM PEF T TED W PUOUE SEWER ia AVAILABLE NRTIRN 300 FEET OF BUDDING) PMC TTSTI.(I NOW MANY <br /> ALLATION WILL SeNC: REaEDET(CE a COMMERCIAL❑ OTHER E] A-0.6-0 <br /> SFR OP LMN6"NRS: � MWASU,OF L WWOOM, <br /> 'ACTER OF SOC TO A DEPTH OF 3 FEET•`, <br /> PR7SL11,EP SOIL CHARACTER: WATER TABLE DEPTH <br /> IE TANRid1EASE TAM 13TYPErNIFo <br /> CAPACITY <br /> RIlATMEM FLllrFr 13 DNEST <br /> RARCI To NEAR : NO.COMPARTMENTS <br /> UFT STATION 0 p;EFOUNDATION PRDPFRrY LINE <br /> HWp ww §i, NO.a t[FIaTN OF Lli_^--- <br /> T1m EBOF PUMP &AMO OIL SEPARATOR EST <br /> MNCLOSED SYSTEArI J <br /> _f—� N <br /> Raw C3 WbTH DISTANCE TO NEAR :yy[µ, <br /> �i� pOUNOATION �PfOpPERTY 11NC, <br /> �F'OTH p�/�T-DEPTH DISTANCE 7D NO <br /> ww C3 warn LENOTM NEAREST:WELL POUATON PROPERTY LINE <br /> �FRA 13 ovrm I, DEtT11 DISTANCE TO NEAREST:1AE11 FDUORTIOM FROFERrytm G <br /> R � DISTANCE TO NEARER:WEly <br /> ❑NRATH LFN6TH FOUNDATON PROPERTY UN! <br /> Tall.roNOt ❑YA.DTN LENGTHDCPRL DISTANCE To NEAREST:WCLL FOUMOATION PROPERTY <br /> UN! <br /> DEPTH-DISTANCE TO NEAREST:WELL FOINOATOW r" <br /> PROPUrrY UME <br /> 9Y CERTIFY THAT 1 HAVE PREPAPEp T/a8 A►FLJCATpR AI0 THAT T!1!wogc WILL SEDOFI!N AC Z <br /> 'EOU.r to, OF THC SAN JOAOUN COUNTY.NOME ON,,*R on ACCORDANCE N,fTN SAN JOAQUN COUNTY ORDINANCES AMDSTATE LAM.ANDMILE O <br /> ONErTRRSVED,I SMALL Not EMK*Y-l'ERWN N SUCH AA Lg^EOAOENT�a SIGNATURECERr-U'r-FOUZMNO:•10EMWYTNATINTHEPO OfMEANCEOFTNEWORx FORVAaCN <br /> 'ONTRAGTSO SOFIATLRE CERTIFIES THE POLLONANO:'I CERTIFY THAT N THE PlRO 8ECOME WSJSCTTO WO{M'•MAN'S CCMFENSATION LAWS or EMIFORNU.`DOIrTRACTOR'8 NSWq OR <br /> LAWS COMFEl18ATSON LAWS OP CAUFOF"A,'TNS APPUCART FMLAhCE OFTHE WORE FOR W/SCN TNR PEAW R EWUED,1 SMALL EMPLOY PERSONS SLl.IEC7 TO C. <br /> MlA1T CALL 3t NOUS W AOVANCS FON ALL RMURED <br /> . ONIpOOTK1Ms. COMPLCTE Cg4pyyp BELOW. <br /> D <br /> TILE: <br /> ROT PLAN-TO SCALER SCALE--I. <br /> MEa OP'OTREE"OR ROADa NEA;"T To OR 90UMNO THE PROPlRrY. <br /> TDR!!OF THE PROPERTY,x'RH QN1XS(O"a AND MOM"bmECTION, 4.LOCATION OF HOUSE SEWAGE IxSFOaAL SYSTEM OR PROPOSED <br /> :MOM COVL8IED AREAS LOCATION OF ALL FXMTNIU AND PROPOSED SERUCTUPES MANSION OF SEWAGE DISPOSAL SYSTEM*. <br /> SDcn AS PAT WS.ORIVCWAYS AJYD WAlR6. 6-MANSION <br /> OF kVp-La W MN <br /> THE PRO RAVi OF ON,MUNORlD F,n. <br /> PETTTY ON <br /> • .. OR ADJOINUl6 PROOPERTY. <br /> c ° <br /> iN <br /> Me 90 <br /> .. <br /> 1F <br /> U <br /> h <br /> t. a <br /> ........__ .................... <br /> PDR DEPARTA®rr UN ONLY <br /> � a 3 « c <br /> �-DATE; <br /> i OR aVMP iNePECTpN 1N f <br /> ``^ DATE I FINAL R+BPECTION BY <br /> Mr r Y T�•' <br /> COPANIENTa• W C DATE-,i <br /> A' <br /> UNTNO ONLY: Ata <br /> FACT <br /> DE F$INFO <br /> AMDcxTREMITTED A:ASH PEGWFD tY <br /> I1 DATi aR!FUSrRi NLaAt61 WygOS s <br /> 10 '� !1 b F,' <br /> S pDv ��t23 <br />