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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 988, 304 EAST WEBER AVENUE, STOCKTON, CA 95201388 <br /> (209) 488-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED - <br /> ICRRPIata M Trogea1a1 <br /> APPLICATION 18 HERESY MADE TO THE BAN JOAMIN COUNTY FOR A PERMIT TO CONSTRUCT ANOiGR INSTALL THE WOR{DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN <br /> JOAMIN COUNFY DEl tW MEM TITLE.CHAPTER 8-1110.7 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SER-VICE..,,ENVIRONMENTAL HEALTH DIVISION. <br /> Joe ADDRESS OR APR, uo W. ( l U r�. Cm L i%ZtfO <br /> LOT SIZE_ <br /> ovJNER9 NAMEIY�WN S/AIJ - ]IJl ADDRE98 7 G. f W� <br /> Y� (z— <br /> T PHONE <br /> CONTRACTOR_ ' kL N er` ADDRESS <br /> LIC, PHONE <br /> BU.CONTMCTOR MME.B <br /> LTCB PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION. PHPANUADDITION ❑ <br /> DESTRUCTION ❑ <br /> INO SEPTIC SYSTEM FERMITTED IF MOM SEWER IB AVAILABLE WITHIN ZOO FEET OF BUILDING.) <br /> FRIC TE.TId 1 1 HOW MAMY <br /> APpdeetlen I <br /> INSTALLATION WILL SFILVE: REgIDENCE,6 COMMERLCIAL� OTHER ❑ <br /> NUMBER OF UVINU UNITS: I NUMODL OF aFDROOMe: {— NUMBER Of EMPLOYED I(j Q <br /> CHARACTER OF SOIL TO A DEM OF 0 FEET: 1 PIT/BUMP SOIL CHARACTER: ^�//''�� WATER TABLE DEPTH <br /> RAP <br /> SEPTIC TANK/OIEASE T ❑TYPF/MFG .1� L. 1 CMACITYyT CZ) NO.COMPARTMENTS [may''.'• <br /> MO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL Idol T FOUNDATION <br /> LIFT STATION SIZE- <br /> OFNT SEPARATOR IENCLOSM SWTEMI PIIOPry UE <br /> LEACR UNS LENGTH OF N DISTANCE NEARF:WELL <br /> MUNDAT"N PROPERTY LINE _ <br /> FILTER RED ❑WIDTH LENGTH DEPFH DISTANCE TO NEAREST:WELLFOUNDATION <br /> PRDPERrY LINE <br /> MOUNDED ❑yMOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE � <br /> SEEPAGE PITS ❑DEPTH <br /> ❑WISIZE NUMBER DISTANCE TO NEAIESt:WELLPOUNDATON PROPERTY LIRE ��cQ <br /> SUM" DTH LENGTH DEM DISTANCE TO NEAREST:WELLFOUNDATON U(�]PIOPERIY UNE <br /> DISPOSAL PONDS ❑WIDTH UNGTN DEPTH DISTANCE TO NEAREST:WELL FOUNDATION <br /> PROPERTY UNE <br /> I HEREBY CERTIFY THAT I NAVE PREPARED THIS APPLICATION AND THAT THE WORSE WILL SE DONE IN ACCORDANCE WITH BAN"AMIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATORS OF THE SM JOAGUIN COUNTY.NOME OWNER OR LICENSED MEW-9 SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT M THE PEPW PMANCE OF THE WORK MR WHICH <br /> THIS PERMIT IS ISSUED,I SHALL POT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO MWMM,g COMFENBATMN LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> SUB-CONTRACTING SONATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PEWORMANCE OF THE WORE FOR WHICH THIS PERMIT 18 ISSUED,1.HALL EMPLOY MRBONS SUBJECT TO <br /> WORKMAN'S COM TION LAWS FORMA.' THE APPLICANT MUST CALL 34HOURS IN ADVANCE FOR ALL <br /> (�REQUIRED <br /> (INSPECTION, COMPLETE DRAWING BELOW. <br /> SIGNED% TITLE: DATE: S — / y} <br /> T PLAN OMW TO SCALE)SCALE •I. <br /> 1. NAMES OF STREETS OR PDMS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE.EWAGE GISMSAL SYSTEM OR PROMSED <br /> T. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISMAL SYSTEM, <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 MEAS SUCH AS PATIOS,OPSWYi AYS,AND WALK, THE PROPERTY OR ADJOINING PROPERTY. <br /> I! <br /> N <br /> 1 p t-LJ GIS <br /> ^ftp <br /> I <br /> Q\ <br /> ,^ pall) %N <br /> fj <br /> y <br /> dt (R e °F pcd°INAY 15 1997 9 <br />