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APPLICAPP'E'-OR llllUiO WASTE PERMIT <br /> SAN JOAGur JNTY PUBLIC HEALTH SERVICES f <br /> ENVIhT AMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 �y J <br /> NOWNEFUR4ARLE PERMIT EXPIRES I PEAR FROM DATE ISSUED <br /> (CmBPVI.h1 TT Wel <br /> APPLICATION 18 HEREBY MADE TO THE BAR JOAOUM COUNTY FOR A PERMIT TO CONSTRUCT AMMR INSTALL THE WORC DESCRIBED.THIO APPLICATION 18 MADE IN COMPLIANCE WITH SAN COP JOAQUIN COUNTY DEVELOPMENT TITLL CHAPTER R-1110.3 AND THE STANDAARRD/S�OyF}SAAN�JOAOWN COUNTY PUBLIC HEALTH 8EMnCER EENN�VIROONME/NTAL.HTALTH DIVISION. <br /> JOB AOORESSIOR/AP�FIF„,. c�'7 e/5- ff,, 004.05 •Zt''' b yam. CITY �SG Il��]��.Fr� - _ LOT BRE <br /> OWNER'S NAME'6 eO"F r ���d�_.___ADDRESS 4+1✓D M LCweS/ rLwNE 5`.�4.3��7r 9/y�4 q k <br /> CONTRACTOR ADORES@ UC/ FHONE I <br /> SUB CONTRACTOR J4-e�� 1 Z;-ef• ADDRESS PE 7-6Z5- UVJ __ LCI 7O/LS _ <br /> PHONE l`a <br /> TYOF SEPTIC WORK:. NLRW M@TALLATION D REPADVADDITIOR 11W OFJTRUCTTON E3 - <br /> [NO SEPTIC SYSTEM PERMITTED T PUBLIC SEWER Is AVAILABLE WITMN 300 FEET OF BURMN8-1 PHiC T-1.I xNOW MANY <br /> APPN-0-s <br /> INSTALLATION WILL SERVE RESIDENCE D COMMERCIAL Ea OTHER C3 <br /> NUNsm DF LINO UMTi: MLMBER OF BEDROOM$: NKMBEL OF EAPWVETJ: <br /> I <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPTH I <br /> SEPTIC TANK/TEASE TRAP I ❑TYPE,MTO CAPACITY NO-COMPARTMFNTS { <br /> PKO TREATMENT PUMP--IT13 DISTANCE TO NL41WAT: WELL FOUNDATION PROPERTY LINE <br /> UPr STATION 0 SIZE TYPE OF PIMP SAND OR SEPARATOR IEIICLOSED SYSTEM) , <br /> LFACHNO LINE 13 NO.S LENOT14 OF LINES DISTANCE TO NEARESh WELL MUHbAlf0N PROPERTY LINE <br /> FILTER SED El WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LORE <br /> MOUNDED El MOTH LENGTH DEPT" DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE Rr@ O vtvrF s m NUMBER DIBTAHCE TO KFAMST[WELLPOuNbATION PROPERTY LINE <br /> @UAW OWADTH LENGTH OEPTOI DIBTAHCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> DI$POSAL FORM WDTTI LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE ' <br /> I <br /> 1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RLAES <br /> AND REGULATIONS OF THE SAN JOAGUMCOUNTY.HOME OWNEROR LICENSED AGENT•@ SIGNATURE CERTIRES THE FOLLUMNO:'LCERTIFYTHAT IN THE PERFORMANCE OFTHE WORK FOR WHICH <br /> THIS PERMIT RI ISSUED.I SHALL NOT EMPLOY ANY PLRBON W SUCH A MANNER AS TO BECOME BVBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUS-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWIND:I CERTIPY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COM NBATgE N LAN7HtiCAUFORMA.�T"WAPM"�AKT USTCALL 34 HOURS IN ADVANCE FOR ALL REOURED INIPECTTIDMO, COMPLETE DRAWING BELOW. <br /> TITLE: ���U-.0-p-13 J irC.� _ DA7E: 2I <br /> v PLOT PLAN IOMW TO SCALE)SCALE_ q I.t7- w <br /> I.NATES OF STREETS OR ROADS NFAREDT TO OR SOUNDS00 THE FLOPFRTY. 4.LOCATION OF HOUSE SEWAOE DMPO@AL SYSTEM OR PROPOSED <br /> 3.OUTLINE OF THE PROPERTY.WITH DIMENDIONO AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3.OIMENSIDNEb OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WMA R WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLLIDMD COVERED AREAS SMH AS PATIOS,DRIVEWAYS.AND WALKS. THE PROPERTY OR ADJOLNIHO PROPERTY. <br /> -- -. - .... J ., - <br /> .. :... .... ...-. .. ... ... .. <br /> . K" L <br /> 1 O <br /> ............... <br /> re <br /> e P <br /> K <br /> w <br /> :a <br /> ' <br /> 7.6 axr I.e n S �`Y C .�. � <br /> y <br /> [ase�,y B ro I' .-, ,.. � ..ISI JN�I .. Ty,.-- <br /> t= • r.[out ..r:, :£io k4VlH L7f,sERvIcE3.._ <br /> t e , i 100 YmlNnm! 17NlWE 7ALHEi'glTh <br /> DIVISION . <br /> rrtw.lr <br /> r — <br /> 4.8.......... : Nu.r*RlKruon " 3j rT 5 I.�. •i krA� 5 r <br /> r <br /> r r.wrrnx <br /> e <br /> ---• - reR 5 e a rv. w � fy IIA V <br /> r. <br /> u, <br /> urnr � - <br /> ,rrr, <br /> .r <br /> ... " n." <br /> .. ^ I' <br /> � � � - � 'OaMdale w " <br /> --- �/•Ifi '? FLIP,°@ i S}7 2 <br /> l 3x <br /> 1.4 <br /> ----.-.-. ...... ;.... <br /> { <br /> '`•'V Y L"'VL L DEPARTMENY USE ONLY ��Z)C V'! <br /> APPLICATION ACCEPTED BY U 4 PATE: ��j1 �C AREA: p,�/ �Oq <br /> TANK,PIT OR BUMP INSPECTION BY <br /> DATE T I fINAL INSPECTION BY I V r 1 f 1 ! ! <br /> ADDITIONAL COMMENTS: h _^ �' £ 7 { <br /> fl <br /> K <br /> ACCOUNTING ONLY. NW FACS <br /> I <br /> PECObE FEE INFO AMOVNT IIDRIITED I C ASH ROL'DVFD SY DATE SR 1 FealaY T(ISIISDI INVOICE/ <br /> 5 21 1 <br /> I <br /> Pub.He&M Serv.-En Aro.174[3198) <br /> I <br />