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�11APET�TfU1�FOR LIOOIO WASTE PERMIT 1�J6t� }I0;.tJ1A�i1N WUNTY PUBLIC HEALTH SERVICES jOhQuw VrMFNTAL HEAL DIVISION 1St vir,() tt�Nl J �N.SAN JOAOUIN tW$TOCKTON.CA 96201.0386 12091 468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED t (Complete lis Triplicate)I, APPLICATION 16 HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.THIS APPLICATION M MADE IN COMFUANCE'MTH SAN JOAOUM COUNTY DEVELOPNIENT TITLE,CHAPTER 9-1110.3 AND TINE STANDARDS OF SAN JOADUM COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL M HEALTH DSION. JOBAoaEssroRaPNe /�� •/rld liCJ a CITY C- C. Lor erzee 04CO& �<�•� ,./��/ '} ��y C OWNER'S NAME ,�1 /TCI ZJ �Y�•C-! ADDIff66 c� /�^C'�� I ..?/k CONTMCTOR �JCLlgally SP�J�%L ADORE-12-( 1"- C-v�C�l' I1 Sf UCI Pow 3 -32 SUB CONTRACTOR ADDRESS NCP RfONE TYPE OF SEPTIC WORK: NEW INSTALLATION❑ 019MWADDITON DESTRUCTION Q RNO SEPTIC SYSTEM PERMITTED K PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PELC TESTW I 1 HOW MANY Appllo•tb1I_ INSTALLATION WILL SEINE RESIDENCE❑ COMMERCIAL❑ OTHER `i( l`l[7LLAf� NUMBER OF LIVING UNITS: NLSflmtlt,Of YFOR//ODMS: B OF..Y.; CHARACTER OF SOIL TO A DEPTH OF 3 FEET:All iR//7_1L R'R/SUMP BOIL CHARACTER: y.��Q��_ WATER TABLE DEPTTI SEPTIC TANKgREASE TRAP ❑TYpr AF'D CAPACITY T— NO.COMPARTMENTS PITO TREATMENT RAW( El DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE Q UFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSEO SYHTEMI _ LEACHING UNE ❑ NO.B LENGTH OF LINES_ DISTANCE TO NEAREST:WEU FOUNDATION PROPERTY UNE FILTER RED ❑WIDTH LENGTH DEPT71 DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MO—DED ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL FOI,NDATION PROPERTY UNE W SffPAGE PTST�Ty.1,DEPTH �SIZE� NUMSER_�DISTANCE TO NEAREST:WELLedV yJ1 rT10[I PROPERTY UFA "1 SUMPS LR WIDTH LENGTH_`DEPTH DISTANCE TO NEAREST:WDJ.TriST__3 FOUNDATION_ O NDDATIIOON PROPERTY LINE DISPOSAL PDNOB ❑NMDTN LENGTH _DEPTH DISTANCE TO NEAREST:WELL_FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCOADANCE WITH SANJOADUAN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULAT10NS OF THE SAN JOAQUIN COUNTY.HOME OWWRO LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT M THE PERFORMANCE OF THEWOPKFORWHICH THIS P93bgj IS ISSUED,1 SMALL HOT EMPLOY ANY PERSON IN SU MANNER AS TO BECOME SUBJECT TO WOWMAN'S COMPENSATION LAWS OF CAL-DF"A.' CONTRACTOR'S HIRING OR Cyt SV4�NTRA ING S1 WI E CERTIFIES THE FOLLOWING:'ICE THAT IN THE PERFOFMANCE OF THE WORK FOP.WHICH TMS PERMIT IH ISSUED,I SMALL EMPLOY PERSONS BUBACT TO W'✓�iKMAN'8 C PE 6A N lA F G RNIA.'THE A CA MUST GAIL a{HOURS BI ADVANCE 1'/01/1`ALL RIEyOIRAl,1R5D ILmPBTLON/.COMPETE DRAWING BELOW.�y� `GNEDX TITLE:s IJ%.//T-�Fc7lY� DATE. ` —2 /-S W PLOT PUN IDRAW TO SCALE)SCALE 1, NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. —_ 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 1111JJJ 2.OUTLINE OF THE PROPERTY,WITH 1"INS10N8 AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. J • 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELLS VMTHM RADIUS OF ONE HUHIAED FIFTY FT.ON MMCLUDG COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. . ........ :C_£t: � 4'r . ..... r I ....< . _ . PAYMENT JUN 2 7 1995 Sfti,v.�ur;truuJ CJUr�7Y Pu8LICHEALTH SERVICES .. COI Ec11�e So.1c'd . ENVI,R.OAIIUEfN.TAL HEA1- FM-0IVI5ii�nl JJ RrY FOR DFPM}MBY7 WF ONLY APPLICATION ACCEPTED BY \[/r _ AREA: Z� TANK,PT OR SUMP INSPECTION BY(Q'� DATE I I MAL INSPECTION 8Y DATE 19� � ADDITIONAL COMMENTS: ACCOUNTNO ONLY: NOP FACT • PF CODE PEE INFO AMOUNT REMITTED 4-4--H 1 ITEC EIVED BY DATE M I PERMIT RUMmYt INVOICE P FR000e`460