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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES 00//98" ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WERER AVENUE, STOCKTON, CA 95201388 12091 469 3420 NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICamplAd in TFpIFttettl AMICATICN IB HERESY MADE TO THE PIAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDMn INSTALLTIN WORT DESCMSEO. THIS APPLICATION 1S MADE IN COMPLIANCE WETH SAN JOAOLAN COUNTY CEVELOPMENT TITE1, CHAPFER 1-1 I 1 O.3 ANO THE BTANDAROS OF BAN JOAQUIN COUNTY PUSUC HFALTH SERVICES, EMVBIONMENTAL HEALTH DINBION. I HERESY CERTIFY THAT 1 HAVE. PREPARED THIS APPLICATION AND WAT THE WORK WILL HE DONE N ACCORDANCE WITH SAN •:OAONN COUNTY ORDINANCES AND STATE LAWS, AND RULES ANDIEOL)I-A TONS OF THEBAN JCAOUIN COUNTY. HOME OV1RlER OR LICENSED AGENT'S SIGNATURE CENT IFE8 THE FOLLOWING: -1 CERTIFY THAT IN THE PEWORMANCE OF THE WORK FOR WHRCH THIS PFRMR ISISSUED, I SHALL NOT EMPLOY ANY PERSON N EN SUCH A MANNER AS 10 BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAtJFOEMA.- CONTRACTOR'S HIRING OR SUSCONTRACTINO BIONAIURE CERTIFIES THE FOLLOWINO: 't CERTIFY THAT IN THE PFRPORMANCE OF THE WOW FOR ~5CH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS A ]WWS/OFFCCALIFORNIA.• THE APRICANT MUPT CALL 24 HOURS IN ADVANCE FOR ALL REMARIED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED 1TRLE: Cajj / AT E: 4�2 PLOT PLAN (DRAW TO SCALFf SCALE _- In I. NAMES Or STREETS OR ROAOe NFARFST TO OR ROUNDING THE PROPERTY. 4. LOCATTON OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2- OUTLINE OF THE PROPFRTY, VATH DIMENSIONS ANO NOREH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTFMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTUR.S, S. LOCATION OF WELLS WITHIN RADIUS OF OW HUNDRED FIFTY FT. ON INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS. AND WALKS. THE PROPERTY OR ADJONRJG PROPERTY. pWMTMENT USE ONLY APPLICATION ACCEPTED eY _ t V DATE:_ TANK, PR OR BLIMP INSPECTION BY [ LL. DATE I cI! CII ` r FLNAL INSPECTION ADOI T IONAL COMMENTS: ACCOUNTING ONLY: I AIUA PE CODE I FEE INFO I AMOUNT REM11 TEG Pub, Health Serv. - Enviro. 174 (3;86) FACE 0 CIIEC CASH RECFNEO eY DATE SR 1 PERMIT 111415li1 3532 L-8 lolln I� (?�/ 3� INVOICE S JOB ADDRESS/OR APNI_ _ �/�/L'.N ��i�/%!/l_ -C:,� LOT W. E , �)/�j'T✓J, ,7 J�jy�L OYVNEJI'B NAME�AV //�I L.r (L /ii (CQV-i-ADORERS T/�,CIYY� �`y �AE CONTRACTOR .TT'7G A -v /'-�L( -IL �yPHONE_y��y ADDNESS Z, %ls ��JP _RICA `+I�?h�X PVWNj��tJ 7��I PIP RUB CONTRACTOR ADDRESS UCF PHONE 7 VPB OF SEPTIC WORK: NEW NATALLA710N RERAIRIAUDITION ❑ DEST71Y0710N O PIG SEPTIC SYSTEM PE.RMUTTEO IF PUBUC SEWER IS AVAILARtF WITHIN 200 FEET OF SUIUIINO.I P91C TUTIM R 1 HOW MANY APl+lo.aon / SISTALLATIDM WILL SERVE. RESIOETICEX COMMERCIAL ❑ OTHER ❑ NUMSER OF LIVING LNITS:-,/ NUMBER OF RFDIIOOMR:NUMBER OF EMPLOYFES: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PFT/SUMP SON CHARACTER! 54,q WATER TABLE DEPTH SEPTIC TANKXMEAAE TRAP ❑TYPEJMFO CAPACITY ND. COMPARTMENTS PKO TREATMENT PLANT ❑ DISTANCE TO NEAREST: WELL z/N, f ryr FOUNDATtON�r PROPERTY LINE. " Sn�.�T UFT STATION 11 SIZE TYFF OF -p _ SAND ORI. SEPARATOR (ENCLOSED SYBTEMI LEACHING UNE I� NG. A I F.NOTH OF LINES LV 'Low Jf T __ DIOTANCE TO NEAREST: WELL UNOATI011L;CU'/ PROPERTY LINE SCi FILTER SED ❑ WIDTH LENGTH:. DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LME MOUNDED ❑ WIDTH I.FNf.TH_ DEPTH DIST ANCF TO NEAREST: WELL FOUNDATION PROPERTY LINE SEEPAGE RTS ❑ DEPTH SIZE NUMBER DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY LINE SLMPA IJWMrH 13 / LENGTH- DEPTH ��) / LRBTANCE TO NEAAERT: WELL�r _�`F9•JNDATIOry 5z/ PROPERTY LARE�JtF� DISPOSAL PONDS ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREST_ WELL FOUNDATION PTRDPERTY LINE I HERESY CERTIFY THAT 1 HAVE. PREPARED THIS APPLICATION AND WAT THE WORK WILL HE DONE N ACCORDANCE WITH SAN •:OAONN COUNTY ORDINANCES AND STATE LAWS, AND RULES ANDIEOL)I-A TONS OF THEBAN JCAOUIN COUNTY. HOME OV1RlER OR LICENSED AGENT'S SIGNATURE CENT IFE8 THE FOLLOWING: -1 CERTIFY THAT IN THE PEWORMANCE OF THE WORK FOR WHRCH THIS PFRMR ISISSUED, I SHALL NOT EMPLOY ANY PERSON N EN SUCH A MANNER AS 10 BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAtJFOEMA.- CONTRACTOR'S HIRING OR SUSCONTRACTINO BIONAIURE CERTIFIES THE FOLLOWINO: 't CERTIFY THAT IN THE PFRPORMANCE OF THE WOW FOR ~5CH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS A ]WWS/OFFCCALIFORNIA.• THE APRICANT MUPT CALL 24 HOURS IN ADVANCE FOR ALL REMARIED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED 1TRLE: Cajj / AT E: 4�2 PLOT PLAN (DRAW TO SCALFf SCALE _- In I. NAMES Or STREETS OR ROAOe NFARFST TO OR ROUNDING THE PROPERTY. 4. LOCATTON OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2- OUTLINE OF THE PROPFRTY, VATH DIMENSIONS ANO NOREH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTFMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTUR.S, S. LOCATION OF WELLS WITHIN RADIUS OF OW HUNDRED FIFTY FT. ON INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS. AND WALKS. THE PROPERTY OR ADJONRJG PROPERTY. pWMTMENT USE ONLY APPLICATION ACCEPTED eY _ t V DATE:_ TANK, PR OR BLIMP INSPECTION BY [ LL. DATE I cI! CII ` r FLNAL INSPECTION ADOI T IONAL COMMENTS: ACCOUNTING ONLY: I AIUA PE CODE I FEE INFO I AMOUNT REM11 TEG Pub, Health Serv. - Enviro. 174 (3;86) FACE 0 CIIEC CASH RECFNEO eY DATE SR 1 PERMIT 111415li1 3532 L-8 lolln I� (?�/ 3� INVOICE S