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SAN.IOAOUIN COUNTY PUBLIC HEALTH SERVICES ` <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST VVESER•AVEME,STOCKTON,CA 95201-388 <br /> 1209♦489-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FRDRI pATE iS5gE0 <br /> ICGmpktn In TrIpikat-I <br /> APPLICATION IS HERESY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMR TO CONBFRUCT ANOXR INSTALL THE WORK DESCRIBED.THIS AFPMATMN 18 MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TIT LE, 9-111 0•3 AND THE 81AN1ARD6 OF SAN JDAaUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH"ABION. <br /> Jae ADORESBIOR APN.T C/ti/� m "� � CITY LOT BREI <br /> PHONE <br /> OWNER'S NAME <br /> `Q AOORE88 IZ <br /> Fill CDNTTUICTOR 5-C ADDRESS LICs PHONE– <br /> F�'4 SUB CONTAACTOn ADDRESS [.ICI PIONS <br /> TYPE OF SEPTIC WORK: NEW INSTA TIION nwD A001TION❑ DESTRUCTION❑ <br /> M SEPTIC SYSTEM PERMNTED W PUBLIC SEWER M AVAILABLE WITHIN 308 VEST OF BUMANNO.I IFTIC T'E6TIei[1 HOW MANY <br /> ApNloAtlon <br /> F1 <br /> INSTALLATION MILLBETIVE RESIDENCE COMMERCIAL❑ OTHER El <br /> OR <br /> Imo! NLPMSOR WINO UNITS: NUMBER OF E.G.:�_NUMSER OF EMPLOYEES: <br /> CHARACTER OF SOIL TD A DEPTH or 3 FEET: PITISUMP SOIL CHARACTER: WA TABLE DEPfN <br /> SE►TIC TANKMN .E"" Q TYPE- CAPACITY No,COMPAITIMENT11 <br /> FKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELLFOUNDATION PROPLHTV UNE <br /> UFT STATION❑ SIZE TYPE OF I1U�LL SAND OI-SEPARATOR(ENCLOSED SVSTEMI <br /> LEACHING UNENO.t LENGTH OF mev _DISTANCE TO NEAREST:WELT FOUNDATION PROPERTY LINS y <br /> FILTER RED YVIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PHDPERTY LANE <br /> MOUNDED ❑%WDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION FRDEEft Y M. <br /> *j <br /> SEEPAGE RT6 ❑DEPTH 9=_HUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE N <br /> SUMPS E3 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE V� <br /> I n <br /> DISPOSAL PONDS ❑WDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY TINE <br /> � IOn <br /> 1 HEREBY CERTIFY THAT 1 NAVE PREPARED TN18 AIVLICATION ANO THAT THE WGPI(WELLSE DONE IN ACCOROANCE WITH SAN JOAGUIN COUNTY ORDINANCES ANO STATE LAWS.AND RUBES (� <br /> AND WGULATIONB OF THEOAMVE AWIN COUNTY.HDNIEONROERORUCENSLDAOENT'BSIGNATVRECfATIF1ESTHFMUDY ONO-YCEHTIFYTHAT INTHE PERPPI"&' OFTR CTOR"'W NoO <br /> THIS PERMR ISISSUEP,I SHALL NOT EMPLOY ANY PERSON tN SIKH A MANNER AS TO BECOME SUSJECTTO WOIRMAN'S COLIPEN6ATAON LAWS OF CAUPON4A.'CONTRACTOR'S RPNO DR <br /> MA&CONTRACTING SIGNATURE CERTIFIES TILE FOLLOW WO:'1 CERTIFY THAT IN THE PERFGRMAHCE GF THE WOICK FOR WHMH THIS PERMtT 18198UED,I SHALL EMPLOY PERSONS SUBJECTTO <br /> T� YYOPLMAN'S COMPLNSATIOH LAWS OF CALIFORNIA,' THE APPUCANT MUST CALL 74HOURS IN ADVANCE ran ALL REDIARES INSPECTIONS.COMPLLTEOHAWING BELOW. f <br /> �J Z' <br /> TREDATE- <br /> MOT <br /> i SIGNED K T :�„1 DATE:�rb/ <br /> t f <br /> ROT PLAN DRAW TO MALE)SCALE—'to <br /> T.NAMES OT STREETS DR ROADS NEAREST TO OR BOUNDING THE PIOPERTY. t,LOCATION OF HOUSE BLWAGE OHIPOBAL SYSTEM OR PROPOSED <br /> Z.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH fAP:CTm N. E HUNDRED FIFTY FT.ON <br /> 3,I)MENSIGNM OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, <br /> INCLUDING COVERED AREAS SUCH AS PATIOS DRVEWAYB,AND WALRB. <br /> ... --..-.�,,,.. .v,.,... r -. <br /> E%P <br /> 6 LOCATION OF VYULS WRHSN RADIUS OF ON <br /> THE PLIOPEI[T'/OR ADJOINING PIIOPERTY. <br /> .. -..c..... - <br /> ..-.. ... <br /> .o <br /> .... :...,, o.,,.. -....., ;,,,.- <br /> AA <br /> I� .,... .. - ., <br /> ' ix l <br /> ..,, .. 0.. . . I.L.IY <br /> f <br /> ..... ..... .......... ............ <br /> .... ...... <br /> ...... .... <br /> ........... <br /> ..... ..... ........... <br /> WIF <br /> r <br /> ... <br /> �� ate. <br /> .. <br /> $AN JOA�UIN COUNIY <br /> ... . ;-.., -...PUB MCc TH SERVICES <br /> .... .... <br /> \ - .... "... .....,,.. BNViF16N A4HEAI.TN.pIV151¢N. <br /> _...:.... . ........ . _ ..:.... ....... .,-.. - ..,...,.. ......v... -_-_,,.. , <br /> FOR DWARTIAENT USE ONLY <br /> Al ACCEPTED T1Y // <br /> TANK.M DR SUMP INSPECTIOI 8Y DATE I I _ FINAL INSPECTION BY GATE UP �� <br /> ADDITIONAL COMMENTS: <br /> ACCOUIITING ONLY: AID, TACO <br /> PE COIF FEEINFO WOLDIYRTNNTED CHIC (CASH RECEiVEd SY DATE MI PERMIT NUMBER INVOICES <br /> -EiL <br /> Pub.Health Serv.-EGYim.174(3196) <br /> f'9`[ <br />