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CNneUNRRtN1AL NtAUM UIVISIUN <br /> P.O. BOX 3110 As; N. SAN JOAQUIN ST., STOCKTON, CA 961-OP-19 <br /> ..i (209) 468-3420 . %Poe <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplleatal <br /> LPRICATION 18 HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND)OR INSTALL THE WOW DESCRIBED. THIS APPLKATION IB MADE IN COMPLIANCE WITH BAN <br /> MAGIAN COUNTY DEVELOPMENTTTTITLE. <br /> .CCHAPTER 9-1110.3 AND FTHHE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> LOB ADDRESSIOR AM# J O0 /] l��/Y/Jkuc' A / /�/� �j�,CIRY /J/�//`I/V�C`.`..FI LOT SIZE_J -� <br /> )WNER'S NAME l , l/I1 q/l 1[(.CY /1{ ADDRESS l�)[/// /i/y��`'! ��'T-A EMNE <br /> :ONTRACTOR / , /� ADDRESS LIC( cf RIONE <br /> We CONTRACTOR A4 f'//�/_FjL ADDRESS POT UCF <br /> 'YPE OF SEITIC WORT: NEW INSTALLATION fid REPANUADDITION ❑ DESTRUCTION ❑ <br /> NO SEPTIC SYSTEM PERMITTED IF PIIBLIC SEWER IS AVAILABLE WITHIN ZOO FEET OF P9 <br /> SUILDINO.I 1C TESTIO I 1 HOW MANY <br /> AT <br /> APPIIaeS F <br /> YtTAUON WILL SERVE, R6IDENCE[I COMMERCIAL OTHER ❑ � <br /> IUMSDI OF LIVING UMTS. NIRABER OF BEDROOMS: NUMBER OF WIFEEFL: _3 OR U <br /> :HARACTER OF BOR TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER T E DEnm <br /> OPTIC TANI/GREASE TILoo ❑TYPE/MFG P, P'4 L1 CAPACITY NO.COMPARTMENTS <br /> XO TIIEIITMENT PLANT❑ DISTANCE TO NEAREST: WELL/? r��T FOUNDATION FT PHOPERIY ONE �.�(M (•_T <br /> LIFT STATION❑ SIZE TYPE OF ROMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> FACING ONE NO.A LLNOTH OF LINES /��;s <br /> T <br /> /]V rr DISTANCE TO NEAREST:WELL )f"F'OUNOATNIN �C/�/�FpOPERTY <br /> PETER BED ❑WIDTH LENGTH DEPTHDISTANCE TO NEAREST:WELL FOUNDATION-/ RO ERTY UNE <br /> IOUNDED ❑WIDTH LENGTH METH DISTANCE TO NEAREST:WELL WUNDATION PIgPERFY UNE <br /> EEPAGE FITS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATIN FROFERTY ME <br /> UATRS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> ISPOSAL PONDS ❑WIDTH UENOTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION FIIDPENTY UNE <br /> HERBY CERTIFY THAT I HAVE PREPARED THIS AKWATION AND THAT THE W01K WILL BE DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS.AND RULLB <br /> NO REGULATIONS OF THE SAN"AWN COUNTY.ROME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHKH <br /> HIS PER/AIT N ISSUED,1 SHALL NOT EMPLOY ANY PERSON IH SUCH A MANNER AS TO BECOME SUBJECT TO WON(MAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S NWNG OR <br /> U"ONTRACTI O SIGNATURE CERTIFIES THE FOLLOWING:•I CEHFIFY THAT IN THE PERFORMANCE Of THE WON(FOR WHICH THIS PERMIT IS 188UED,I SHALL EMPLOY MIN O CO SUBJECT TO m <br /> OWMAN'S COMPENSATITION�LAM OF CALIFORNIA.- THE APPLICANT MUST CALL 34 ROW IN ADVANCE AOR ALL REOUR7E7D-INSFIEC.,TIIO�N�S. COMPLETE DRAWING BELOW. 1„ <br /> GRED I_ V� ' i � ! �� TITLE: ('i7/!A/7 f-•.(.CH DATE: <br /> ROT PLAN(DRAW TO SCALPEL SCALE .I. ES) <br /> . NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE FROPERfY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRDPOBED Q <br /> . OUTLINE OF THE F/KIPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DIMENSIONED OUTLINES AND LOCATION OF ALL EXNTNG AND PIIOPOSED STRUCTURE, S. LOCATION OF WELLS WITHIN RADNB Of ONE HUNDRED FIFTY FT.ON� <br /> INCLUDING COVERED ARAB SUCH AB PATIOS.ORRVEWAYS.AND WALKS. THE PROPERTY OR ADJOINING FROPENT f. <br /> yoSel" c= R A <br /> PAYMENT <br /> RECEIVED f <br /> MAR 2 199 J <br /> 6& 4 JE7AQUIW rQUI ITY 9 --�-- <br /> f40B1:Ir_1AEAL1HSFI0rICES D/ <br /> tPHIRJfJN1 VITAL FIFAt11II )WIS(OD: 1 1 <br /> ��T7y 11E <br /> � I <br /> i <br /> Iu� <br /> VNILA <br /> nl �� i'1-• ` Sn P`•T � �k0 Q 1,/Yk E'iti/�'j/ <br />