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APPLICATION ACCEPTED EY Fon DEPARIIMENT USI OMY DATE: - 5 fl 14454. ITT OR SUMP ONSPECTION SE DATE / FINAL INSPECTION bY ADDITENUI COMAE:RS: Cr NAT PLAN MAAW TO SCALE) OcALE tomes OF ST1ZErrn On ROAM NEAREST TO OR BOLMOINO THE PROPERTY. OUTLINE OF THE PROPERTY WITH CAMENEIONS AND NORTH CEPECTION. J. DIMENSIONED OUTLINES AND LOCATION OF ALL EATETTNO 5110 P10P0800 ITINucTURES. INCLUDIPM COOPED AREAR RUCH Al FATIOS. DRAW:AYR AND WAND. rT DATE N 4. LOCATION OF HOUSE IMWACIE DIFOSAL SYSTEM Oft riloPonto EXPANSION OF SEWAGE DISPOSAL SYSTEMS. I. LOCATION Of WELDS WITHIN RADIUS OP oNE inaioar0 FIFTY FT. ON THE PPOPERTY OFI ADJOINING 10113fER/Y. c\c't, CoLvi",p 14-c)a-c Lnis u0A1J1,204 -PUB ITCALTPi beliVICar .04V1RONMENTA4.142A1,Tk.0414211.01,1 '54-c IITLEL C) DEle, PELF.A1 AT APPLICATION FOR IMO WASTE PERMIT 'CC? SAN JOAQUIN COUNTY PUBLIC HEALTH 6 'S ENVIRONMENTAL HEALTH DIVISIOTI 4111131=m. 01111LIel Mita. 121VIIIKM 304 EAST WEBER AVENUE, STOCKTON, CA 95202 1209) 488-3420 SPECIAL PUNT NOKREFLIMPARLE PERMIT EXPIRES 1 YEAR FROM DATUSSMEO ramsirts la Moir-ale) nroUCAllon 12 HENEDY MADE TO /HE 4AN 10501154 COUNTY FOR A PENNEY To ooNsyRocy AND/Olt pygrALL THE WORK DEBLISMD. TIM APPLICATION 10 MADE IN COMPLIANCIES/TN IAN Jammu eutm,-y DEmopmENT TITLE. CHAPTER I.1 1102 Am THE EITANCIARDS OP SAN JOACIVIN COUNTY PUBLIC HEALTH SERVICES. ENVIRONMENTAL HEALTH ORISON. ION ADDRESSTOR AM/ 1100 pvz.,„<_.1,, C 4 MAO R(.9 arY FV e In C-14 CCi ot 0 nu' OWNEHR twin_ 1 P t-,5s -.1 a I, P1S40 V1 *DORM CONTRACTOR .):-.L.L.0 1, T at., /so ,A5 ADDREss 9 000 N LA, l'. 15 0 11 L.1.1C1.. uc • 140e.% S-1 I prorm 9“-no 7 MR CONTRACTOR ADOREss LICE NHONE FiFahr ??.2 -6 333 TYPE OF SEPTIC WORK. NEW INSTALLATION 0 REPARVADollioN 754 OrEVERLIcnoN 0 IMO sumo SYSTEM PERMITTED II EMILIO SEWER IS AVAILARLE VvNFUN 200 FEET of MUL00I4.1 1171114.1 1 NOW RANT AMR:Mon 0 INST ALUITION WILL I00VT. REINGENCE 1St COMMERCIAL ID OTHER 0 51115455 0f LEVINE UNITS 1 ,dumlin OE SEDIDOOMS. NUMNEN OP EMPLOYEM CHARACTER OF SOIL ID A OEPTH OF a ?En . .56,‘,1C/2? RENIUMP WE CHARACTER 5 CL \•‘C; \.) WATER TASTE DEPTH /5 SEPTIC TANK/TJORUIE TRAP TYPEm xi CAPACITY I'S 0 HO. cOMpAREVENT0 PRO TREATMENT MAIM 0 DURANCE TO ITIANENT: WELL FOUNDATION PROPERTY uNE urr rrienon 0 60E TYPE OF RJE4P SAM OIL SEPARATOR ENCLOSED BYSTEMI LEACHRO UNE 0 NO. a truoru OP men PRDPIRTY UNE ODNANCE To NF_ANETT, vALL FoUNOAnoN ALTER MED S W1OTH_LIL LENOTNiaL. ocrru 2. ( DISTANcE TO NEAREST: WELL SO (-1.- FOUMIATION /(./ 1 PROPERTY UNE 5- 1 MOUNDR2 0 vrcrrn ?DEPTH DISTANCE TO NEAREST: WELL. PROPERTY LINE FEWIDATION SEEPACR PITS 13 DEM LENGTH SIZE INITANCE TO NEAREST: MU MUNDATION PINORENTY LAE M.IMBEI1 MIME 0 W1CrnF LEFOTH DEPTH DISTANCE TO NEAREITTT WEI MUMATION L Fourorrv ME DEPTH DISPOSAL poieDs INSTANCE TO WRIEST: WEU. FOUNDATION D WINN RIOPERTY UNE LENOTN FIEREsy cENTIFy THAT I NAvE ppEpARED THIS APPLICATION AND THAT 754 14054 wILL SE DONE IN ACCORDANCE WITH IAN JoAoVIN COUNTY ONDINAM:Ea ANC, STATE LAWN AND Rtai APIO MULATIong or rrin SAN JOAQUIN COUIFTY. HOMEOWNER OR DC-EMBED F.serre moNATufrt torn THE FOLLOvAINL ICENTITY THAT IN THEPERFORMANCE OP TIMMONS. PORWHICH TINS PFPnar MT EMPLOY ANY PERRON 14 RICH A MANNEA AS TO cos/* 545.507 TO WORKMAN.' COMPENSATION LAWS OF CALIPORMA." conTnAcroirs RPM OK SUS.CONTIV.CTING CERTIRES THE foLLOWNO, I CERTIFY THAT IN THE PERFORMANCE OF THE WON( FOR WHEN ME PERMIT NI tINIER. I SIMI EMPLOY PERSONS SUBJECT TO WORCMAPPS CO LAWS Of CA054SATE5 APPUOANT MUST CALL 24 HOLIES PI ADIFP.SCI PON at IMOUIPED IIMPECTIONI ODIAMETEDIENNINO MOW. ACCOUNTWO COE 1/2, I4 , AI a, PACE PE CODE fr FtE IN0 • AMOUNT MAIM 14ESK /CASH MEclaVED $T DATE 1111 PERMIT INVOICE 0 ....4-745 Ait %., 1-5q) oc) i .1.9.--7.-.5---..— ,i2_/ ,..me-....---..."."--•--,-- Pob Hanith Sero Enono 174 MSC