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N JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> k_ ENVIRONMENTAL HEALTH DIVISION <br /> PD. BOXSK 3D4 EAST WEBER AVENUE, STOCKTON, CA V3MIX88 <br /> (2891468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER! <br /> (Complets In Triplants) <br /> APPLICATION IS HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED, THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAN <br /> r7 JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION, !� <br /> ' JOS ADDRESSIOR APN/ i A���� ISI a i E'rp C.R ���r.� CITY L—Z� LOT 8RE ,„�1 •CC,!'r �j <br /> �-+ OWNER'S NAME jVl.rc 2 ,,.fk lrL�l` ].ADDRESS— U 71�E� p '�' �7 PHONE �2� E�y�-j 1 <br /> M1 CONTRACTOR 144'�N D r_SI�O{Z�( ADDRESS IG�� 1N - LICK ` PHONE J `L� -[ <br /> SUB CONTRACTOR ADDRESS*5TyNi lq�2 L2` I tI I Q <br /> �GTT LICN PHONE <br /> tYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPANVADDITION RL DIaTRUCTION❑ <br /> i, <br /> (NO SEPTIC SYSTEM PERMrrrED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.)' PMC TESTI,J I 1 HOW MANY <br /> S.� <br /> AppHonBon N <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 13OTHER 13 <br /> NUMBER OF LIVING UNITS: 11 NUMBER OF BEDROOMS: NU KMER OF IMPLOYWA- <br /> -. <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET:_g2j�ftle PITISUMP SOIL CHARACTER: L-OAr't 10.1 ATEA TABLE DEPTH 745 <br /> SEPTIC TANKJGREASE TRAP 13TYPElMFG_7�i rj'[-L(1..►, CAPACITY NO.COMPARTMENTS <br /> PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LWT STATION❑. SIZE TYPE OF PUMP AN EPARRATOR IENCLOSED SYSTEM! .may <br /> LWHINO LINE faF NO. LENGTH OF LINES I- - 0 J L DISTANCE TO NEAREST:WELL Z�JO r� FOUNDATION Q 40 PROPERTY LINE cl t <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> MOUNDED ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE :. <br /> I SEEPAGE PITS Ila DEPTH 25 R SIZE 3L -J NUMBER Z' DISTANCE TO NEAREST:WELL,�y FOUNDATION SD PROPERTY UNE <br /> SUMPS 11 MOT" LENGTH DEPTHDISTANCE TO NEAREST:WELL FORINbAT10N PROPERTY LINE <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH - DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> r <br /> t <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK.WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFYTHAT IN THE PERFORMANCE OFTHE WORK FOR WHICH <br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORMA,' CONTRACTOR'S HIRING OR <br /> BUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,i SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPETE DRAWINO BELOW. <br /> SIGNED X <br /> TITLE: C� c DATE' �L I `tivJ <br /> PLOT PAN(DRAW TO SCALE)SCALE "to <br /> I. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. - 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATm,DRIVEWAYS AND WALKS THE PROPERTY OR ADJOINING PROPERTY. <br /> ..... - '- <br /> 1 . <br /> .... ... .... - ...4.. <br /> 09. <br /> 4S"..... ...............? <br /> _.�[� <br /> ......... <br /> .......... <br /> .. <br /> ..... <br /> .... <br /> ... <br /> ...... <br /> ........ <br /> . r .... ...... ......... ....... <br /> STJ ............ <br /> ......... <br /> .... <br /> ...... <br /> °.. <br /> N. �. ... ....... <br /> tw <br /> ...,. �'oimP,ry fi <br /> MAN 1.4...15.99 .... <br /> aF 1 tOAQ4 iN( INS <br /> ;.. . <br />`— PlIouc HEALTH S�FNIGk - <br /> :. EWIRPNMErN .....:,. . <br /> ........... <br /> .... <br /> ...... <br /> .... <br /> ... <br /> ............ <br /> .......... <br /> .... ....... <br /> ...... <br /> .. <br /> .. <br /> L-S <br /> ........ <br />