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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388, 904 EAST VVESEA •AVENUE, STOCKTOK CA SMI -MB <br />(209) 461.34ID <br />REFUIDABIi PESIRT EXNV*S 1 7!1111 FRDAT IDA7 <br />(GnpiEa 4 Tc%&s* l <br />APRJCA-rVN K W MlY LEADS TO TTM SAN JOAQUIN COUNTY PON A MWrr TO CONSTRUCT ANOATII INSTALL THE WOM MOCHSFD• TMS APPUCATION Ii MADE N CO OUANCE VAT14 SIAL <br />JOAOLRN COUNTY DEHAOPMHR^71711, C%APR%0-,i ^10.3 AND THE STANDARDS OF MN JOASMIN COUNTY PUIUC HEALTH INERV 88, ENVVION&WITAL HEALTH MASON. <br />'JOS ADDRESSAOR .VAI •S LI riSIwJ '1�''YYG�e!11'� cm_C�Q,;,� LoT_M7i A=q25 <br />OVRAE" HAALe�1$C �L L A0011ESa YY e 1 PHOIM 9lIP - 3 1wQ <br />mNTMCTOR_ `-� ADOW811 l'd-9L's� n S\w+. ucr h vHOIM� b�-r7S'°�33 <br />SUSCOMMCTOn AOIDAI! UC• P1gN_ <br />TYPE OP SVTC WOIS: NEW IIATALLAmse ❑ 11EPASUADOfAON ! DSSTRIICTION ❑ <br />TND SEPTIC SYSTOA PEMARTEO F ?USUC SEWER IS AVAKAaLF WrTHIN 700 FEET OF "KDI NO.I FGAC TSSTN) I I HOW MANY <br />APPI I . r <br />NSTALL.ILTION WILL SANS; FEagETil•.E � COMAENCIAL OTHER <br />FAG+ <br />IIt/AiSt OF 041Na tNa7L:I_ NIIM\H1 O! iIDROONa: 3NI1NN61 OF LMROYQS: <br />�fll,�F a011 TO A DEPTH Of 0 EEiT'. I D Pen PIT42; 5011 CHAMCTER:� -WATER TASTE OEPfH 1 _ <br />a 7Mr OfTYPFAAMO c' CMACTTY II_ �i0 c <br />No. CONrARTA1BITY +ti <br />PRO TISAT&MY RANT ❑ DISTANG1 TO NEXAAST: WELL FOUNOA710N <br />PROPERTY LINE, <br />IIT STATEN ❑ NZE TYPE OF PUUP SAND OIL SEPARATOR (ENCLOSED SYSTEM 1 <br />N <br />LIACFNIO LIR lim NO. A LDWTH OF UNES�/ 2.') L40 DISTANCE TO NEAREST: WILL <br />%jaa FOUNDATION �� WCPMfy LINE �� <br />PETM a® ❑ LYTOTN LENGT%_ OEPTH DISTANCE TO HEAMST: W!LL <br />FOLNOAItM PROPERTY tm <br />TO NEAREST: WELL <br />rrH DANCf RE <br />MOLIIAFL ❑ WIDTH LENOTH OEAT <br />'�- <br />FOUNDATION MIDP@1TY LIR <br />DEH S@ NUMBER DISTANCE TO NEA EST': Witt <br />GULP 101 RTS 13PT <br />FOIIPPJATON PROPOCTY LAW <br />NIALPS is WAIT"� IENOTN / O U_ DEPLH !n , DISTANCE 70 NEXEST: NA:7-L <br />Q� FOrJ1OAT10N i4ra + PROP61fY LIFE` s�Qd F <br />MWNK MHOS ❑ WtUTN IFNOTN � DEPTH pSTANCf TO NTiVEST: N/fll <br />IOI/UATION PROPERTY LINE <br />1 HDElY CEIUTFY THAT I HAVt PIEPAAEO THA APPLICATION AND THAT THE WORK VALL N DONE IN AOCORDANCF. WITH AM 40AGLNN MARTY OIUNAIAM" AND STATE UWS, AND "In" <br />ALU IMOULAT1ONS Of THE SAN JOAOUIN COUNTY. NOW OWRER 011 UCPNSED AOENT'a SMNATUF CENTRALS THE POUDWINO:'1 CERTWYTHAT N THS MLlN UNCE OF TIM WORK FORWIMH <br />THIS PE1EVT 18 ISSUeD. 1 SHALL NOT DANDY ANY IERSOH VI INCH A m.'.mHER Aa TO BECOME SUa=7 70 WOIKMAH'S <br />COAIENSAT)ON LAWS OF CA1SiNNN .' CONTAACTOR'S HVNq OR <br />SUa•OONTIACTINO /10HATUE CfTTVMS THE FOLLOWING- I CURVY THO.T N THE PERFORRIANCE Of THE WOM FOR WWCH THA PE]NTT N WKWO. 1 SHALL HULOY POHONS OMACT TO <br />WO(KMAN'a COM 1CALIFOIVSA` AFMICAR MOAT CALL IK HOW 1N ADVARM FOR ALL R/DUSEn Il/friC710N/. COkWUTt DRAWING a9 <br />LA741 <br />11I7/0N <br />'g;,THEs <br />mT.—Q. <br />alaNx �, rte. __ � =- Trf —Q <br />&]DW. <br />Q p <br />DATE: <br />ROT RAN IOEMW TO OCALEJ SCALE h <br />1, wall f Of FTFLETa 04% IIOAOS HEAIELIT TO On HoON0LN0 TIE PROPERTY. A. <br />LOCAT40N OF HOUSE SEWAGE DISPOM LTYSTDA On PROPOSED <br />}. OUTLMt OF THE PROPERTY. MATH DEP ENSONS AND NORTH DIRECTION. <br />O. PMENIN OMM OUTLIES AAO LOCATION OF ALL OUSTING AND PROPOSED K % 0_5 S- <br />EUPARSUH OF SEW AGE DH 044%t SYSTEM. <br />U.00ATIOH of WOLS WITHIN PAW" OF OPE IUIURPD FIFTY FT. ON <br />INCLUOMO COITFED MEAS SUCH AS PATIOS, D1aVEWAYS, WM10E Y -TIRE P110 AUIONxNO PWPERY. <br />e <br />1 ... ... ..e... .. .. ,- <br />' <br />.1 ...: <br />��., <br />L,A <br />1 <br />T <br />R1 199. <br />,. ... ...... ....... <br />nT Irlrii nNcqu <br />EtEY H NU(, M <br />......... . >............ .............. ...... <br />i <br />FOR DVAPTAANT WI ONLY <br />, f/ <br />APPLICATION ACCEPTED my`� / _' C.G tI'�.��• oAtt: <br />,} <br />.7 l! <br />QJ�� <br />�` <br />,, I QO <br />FINAL Vtcm%SY �>='^^' "^—^ DAT! / A <br />OR SUMP INEC7rXJ VY DATE AP <br />TAMC. PR SP <br />ADDITIONAL COLOMENTS: <br />0YAY: NOF <br />FAG+ <br />Fu US -O AMOUNT MMYTaO <br />CIIECR• MN AECAVEO SY <br />OATS <br />M I rEWST NIIMSR INMOC.a S <br />rACCVUP(T'C"IQ <br />115 <br />111 19 <br />00 % <br />PIA HWIh Sarv. - Envtw. 174 (3186} <br />