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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201.386 <br /> 12091469-3420 <br /> ROPEREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> k11114- XW pktm in mpli e.1 <br /> APPIICATNNN IS HERESY MO THE SAN JOAWIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR V4TALL THE YANK DESCHI ED.TISK APPLJCATION 16 MADE W COMPLIANCE YRTN SAN <br /> JDAO AN COUNTY OEVELO��ENTT ITTLE CHAPTERS-111 O.3 ANO THE STANDARDS OF SAN A AWN COUNTY PUDUC HFJ AfI E6,F}1VYbNYFIFPK HEI TN OM90N, <br /> J06 ALNRIESSOR APNr{1 I 1[SY ((y(PA cm'_� ''O -�t� LOT alrz �`9G <br /> OWNER'S—c- -s4--.-s4-- 04j� ,14ADORESS S�✓1.-C/ WIME Jln>A.i, <br /> UCI t0!lDrCSY'H PiONE �11-•r�7' <br /> BUS CONTRACTOR_ AOORESS MR PHONE <br /> TYPE OF PFJmt WORK: NEW INPTALLATIUH R6MUAO""Ost❑ DFfT1Y1CTIOM❑ <br /> ,BIO eETTIC SYSIEN PCW.STTEO F PUSUC SEWER IS AVARABLE WITHIN 200 FEET DF SIISOS+TI.I FERC TYTh/1 1 NOW MANY <br /> AFplwSen <br /> INfTAILARON LNILL rB m REENOE.`ICE W COMhERCl-❑ OTHER❑ <br /> Numm OR UVWO UNTlI_WR-ER OF S m//R,*wT T IIIIRSt6T OF WPLOYRS: / �E –" <br /> CHARACTER OF BOR TO A DEPTH OF J FELT:, PITMUMP SO&CHARACTER: .S•MU WATER TABU .J 0/�, — <br /> SaFm TANKAORFASE 1SA► �TVPEITAFO t"I CAPACITY t ->1 n No.COMPARTMENTO�'/ <br /> FKS IMATME" PRAM❑64TANCE TO NSARD.T: WELL I�tE FOUNDATION l PROPERTY UNE•_ <br /> UFT STATION ram TYPE OF PUrM-P� /= 9MD OIL SEPARATOR ENCLOSED 6YSTEMI <br /> LEACMNO ITIS p NO.A I TH OF LINES t^ -TTS 1 DISTANCE TO NEAREST:WELL Ion' FOUNDATION 16 PROPENTY UNE,i–� r"l <br /> ALTER S® 13 WIDTH LENOTN DEPTH INSTANCE TO NEAREST:WELL FOUNDATPJN PROPERTY UTE <br /> MOIMDm �❑I"DTH IENOTN DEPTH DISTANCE TO NEAIWni WELL FOUNTM:TKN/ PPOPaTTY U1S: <br /> SSIDASS FRf p NEPiH C�r plg L� NUAbERDISTANCE TO NEAREST:WELL ��[7 I ROUNOATION-,-j,0- _PROMMY LINE <br /> WARPS 1�1I WIDTH LENGTH OFTH DISTANCE TO NEWEST:WELL FdxIMTION PROPERTY LINE <br /> DISPOSAL POLOS LJ MRDTIR LENNJTH DEPTH DISTANCE TTI NEAREST:WELL PJVNDATMN PROPERTY UNE <br /> I HEREBY CERTIFY TEAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOHIC WILL BE DONE W ACCOADAMCV.WM SAN JOAQUIN COU TY OIOWANCL6 AND STATE LAWS,AND RULES <br /> AAD IEOVLHTIONL OF TFEeNi JOAOUM COUNTY,NOME OYANEROR IK.ENBFD AOENT'8 81SNATIRE CIDITTEYTHE FOLLDWNO:'10ERTIFYTNAT piTHERWOW.IAHCE OPTHE WOR[PORMA.•H <br /> TM6 PEIAST IS ISSUED.I SHALL NOT ESPLCY ANY PERSON IN SUCH A MANNER AS TO 6ECCME WWECT TO WONKMAN'S COMPENSATION LAWS OF CALIFORNIA-CONTIIACTTHI.B MMM UR <br /> S ONRA M SIONATUE CERTIFIES THE FOLLOWINO:'I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WWCH THIS PENAT 16IBSUFA.1 SHALL EMPLOY PERSONS SUBJECT TO <br /> LYOIKMNJY COMPENSATTIONN LAWS OF CALIFORNIA.' I <br /> �A.'TM APCANT MUTT CALL] HODST U ADVANCE FOR N NOWAKM WAMT10".COMPLETE DRAWSVLT ln&W-��'�f�—C��- <br /> " x { <br /> —_.LA. �.L�� mLE:�1+'1-F-j'cc�j3!' DATE,-_ <br /> t/ if <br /> _ PLOT PLAN S1RAW TO SCAM SCNE •ro <br /> T.NAMES OF=ME"OR ROADS NEANEeT TO OR BOUNOlM THE P,CPERTY. l LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> S.DUTUNE OF THE PROPERTY,WITH OSAENINO"AND NORM DIRECTION. EKPAN/ION OR SEWAGE DOWIOSK SYATrM*. <br /> O.DIMENSIONED OUTLINES AND I0CATION OF ALL ExWTINO AND PROPOSED 471KICTURM E.LOCATION OF WELLS WITHIN RAMM OF ONE HMVDREO FIFTY FT.ON <br /> INCLLN)"COVERID AREAS SUCH AS PATIOS,ORVRWAYS.AND WALKS. THE PROPERTY OR ADJOINM PlIOP[RTY. <br /> 5t7�L <br /> OSS�A'Idfill <br /> ' .. <br /> S Z . <br /> lol-rtL. <br /> 7� <br /> JC>,atAilfNCLUNTY <br /> :._...:. <br /> EIJWIMEMA.NEALTteENY <br /> FOJR DBARTA16Vf L.SI ONLY <br /> AJ <br /> �ATCATION ACCEPTED BY�_ �oC. 'r�'^�' RTE• 2, ATEA) Z Lt <br /> (yMlK,,pfyT_OR2SUMP M`BMCTION BY Yat i'A ltk'ldnd -. ,EDATE I Z3 117 FINK WSPECT.ON 6Y DATY 121_Z,T I.S"I <br /> ',AO✓pTRf/NK CpAMENT6: <br /> ACCOVNTINS OIN.Y: NW FACS <br /> (PECO PEE INFO —UNT PAPANTED GEC CASH RECRVEO 6T DATE "1 PD1MT NIS.OER INVOICE 0 <br /> 0 SO <br /> PL:o.HAABn S—-E-IM.174(,W6) <br />