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APPLICATION FOR LIOUIO WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES L/ 11'. I I,:�; R•;) t ENVIRONMENTAL HEALTH DIVISION S� P.O. BOX 388, 446 N. SAN JOADUIN ST., STOCKTON, CA 96201.0388 dj /�E�• (209) 460-3420 APR 2,114 NONREFUNDABLE PERMIT EXPIRES / YEAR FROM DATE ISSUED E!\VIROI' INAFI`JIAL rIEALTH IC$STRUC in O/011 I$L$1 EfFpAA1T"/C{ I. e-c IRRIGATION IS HEREBY MADE TO THE 6M JOAQUIN COUNTY FOO A PEPMR TO CONSTRUCT AND/OR INSTALL THE WOFK DESCRIBED. THIS APPIIOAT I.iAUE x4 tOM6u WrtH am 1 JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB AODFIESSMR ARI# TLS SOo N.,44, M -_W-;r<-�flf J. C' /� 1 Cm 7.4c„ \"+s LOT SUE_ OWNER'S NAME EnSf EAU, M•LA.J JO ADDRESS3/J` 111A S - AIL IcA r,cl (�4 iy607 RroNE(S/D)?S7-165./i CONTRACTOR Up.:-1-c Cel 141.. <:h'o.X ADDRESS/6Z•K/ E. A,/oo nc Avg. � uc#7Z/71CD NIONLZ23N63- 93 SUBCONTRACTOR ADDRESS LIC# PHONF TYPE OF SEPTIC WORK: NEW IN$TALJArON)q REPMRIADDITION ❑ DESTRUCTION ❑ ILIO SEPTIC SYSTEM PERMfrtED IF PUBLIC SEWER I6 AVAILABLE WNHIN 200 FEET OF BUILDING.) PERC TEATI.)I I HOW MANY •iR P"1;c APM«Sun# INSTALLATIONWILL SERVE: RESIDENCE❑ COMMERCIAL❑ OTHER q �:L1. No.+c/+RV IL- NUMBER OF(MNG UMMB TS: NUMBER OF SElROOMS: NOM{61 OF BAR CHARACTER OF SOIL TO A DEPTH OF 3 FEET: (::_ Iate PIT/SUMP SOIL CHARACTER:_ R o�.1� WATER TABLE DEPTH 7S M SEPTIC TANK/OREASE TP El TYPEIMFO CAPACITY L NO.COMPARTMENTS PALO TREATMENT PLANT❑ GUITMCE TO NEAREST: WELL FOUNDATION PROPERTY UNE NFT$TATION$I EZE 3Sg pF'n TYPE OF PUMPSL�!+R/t.E.IMSAND OIL SEPARATOR(ENCLOSED SYSTEM) L�PROPERTY LINE LEACHING UNE ® NO.M LENGTH OF LINES C$. I00 f*. DISTANCE TO NEAREST:WELL- 15 FOUNDATION (\ FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE ^I MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION �('1 PROPERTY UNE SEEPAGE RTS ❑DEPTN��SIZE j:&NUMBER�ITT��DISTANCE TO NEAREST:WELL P-30 FOUNDATION,��PROPERTY NNE LUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL POND$ ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULE; - AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNAMRE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUB-CONTRACTI SIGNATURE AERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED.i SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S C NeATO 6 FORMA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRE)INSPECTION$. COMPLETE DFUMIINO BELOW. PSIGNEDx TMI-E_Capital Projects MEtr.DATE: II PLOT kAN DRAW TO SCALE)SCALE ! -1. 8 o f+ 1. NAMES OF STREET$OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.1 LOCATION OF HOUSE SEWAGE DISMSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED MEAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. 100-Z - O/6 �;nity Locai;Dn n� 100 - G- 02.1 P/an - I 100- G- ozz, n/an-Z /00 M- 605 J7ctw; 15. /00 -E - O / l E/ech.; S 4 LILT 2L4a /do -,E - o/z_ EIS, ,:LAIC S SC', PIKS.) MAY glom SN(J JP: '�IUIN COUN1V IL;LJC'-IF:ILTH SERVICES `J 141 M-FIEALTI I(1N)S 1111 APPLICATION ACCEPTED By —©DATE: gppq, (L"l�/^ T ,MN0R SUMP INS, C�TITON BY / DATE / / FINAL INSPECTION ADDITIO COMMENT I U F y ACCOUNTNO ONLY: AID# FAC# M CODE FEEINFO I AMOUNT REMITTED CIS9 /CASH RECDVFD Y WE YR/PpW11TN INVOICE G, of 7- 3 - eo ,Pcr-41-cT,qs 4{,'t �i F� . �erm/os s t Ura a c zz L e 7 e e 4a ��orpk 8 -q 00 9a 1"17(04.3 1/1Gwr�l UM/-� I)DEJ JaYlGgy ' p -17,1e on 4(1P �P4tfcjh - q-P--