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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE$ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Q.O.BOX aaa San EAST WEBER-AVENUE,ST ICKTIO t, CA 9=t-W <br /> (2091 469.3420 <br /> NDN-REFUNDAELE PERIIAIT EXPIRES1 YEAR FROM BATE ISSUED <br /> ;CBaVlBTS IR TripReatal <br /> APPLICATION Is NCREBV MADE TO TIRE WAN JOAOUN COUNTY FOR A PERMIT TO CONSTRUCt AND/OR INSTALL THE YAM nrsCRSED.THIS APFLJCATIOA'18 MADE IN COMPLIANCE WMI BAN <br /> JOAQUIN C•DUNRV b"LOPMENT TME. <br /> /CHAPTER B-1110�.3JAND THE BTANDAFDS OFF7BAN//p�AeuN CeuNTY"IAC HEALTH OEA+T�CEB.WHVBOMAENTAL HEALTH DIVISION. <br /> JOB A0011[BS+OR APHO 9�6v V „/ +4.{v21/1 C Y•L—C C.&�'F•+� _LOT E�JV_TqQ q�q�S� <br /> � DwNFR•B <br /> CoNrRACTeA 'L'+775G _ ADonESWf�/ � u uca�� FwoNE_ <br /> NVB CONTRACTOR ADRPBBB LICE PHOFPZ <br /> TYPE Of SEPEIC WORD: NEW 1-IIALLAT10N REP^poAOTATION DDaTTHICTIOH L3 <br /> DPO SEPTIC WYRrfif PERMrlITED IF RISLJC SEWER 10 AVAB_AME VA TH/N 700 FEET OF BUADINO.I FMC TESTLA 1 I NOW MANY <br /> APPL-tlnn <br /> 1NETALLATION WILL SLTIVEI REBIOLN:.E V3 comiAERCIAL❑ OTHER 11NUMSM OF LIVING UNITS-_NWEER OF BEDROOMS: N"Mil OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF ll FEET' PTISUMP SOII-CHARACTER' WATER TABLE DEPTH <br /> SEPTIC TAIVIVa1EASE TRAP ❑TYrfwFO CAPACOY NO_WMPARTMENTL C> <br /> PRO TREATMENT PLANT❑ DISTANCE TO NEAAEST: WELL FOUNDATION PROPERTY L.NL <br /> LIFE STATION❑ WE TYPE OF PUMP _ SAND OIL SEPARATCF(ENCLOSED GYSTEMI c> <br /> LEACHING LINE ❑ NO,%LENGTH OF LINES_ �— DISTANCE TO NEAAEBT:(HELLFOUNDATION PROPERTY UNE O <br /> FILTIF SED ❑vAoTH LENGTH DEPTH DISTANCE TO NEAREST:WELL _FOUNDAP.ON PROPERTY LINE <br /> O <br /> MUNDED ❑YcWTH LENGTH DEPTH DISTANCE TO NEAREIF`:WELL.^ FOUNDATION RROPER'TY LINE <br /> •®AGB ATS ❑DEPTH W7E ^Y NUMBER OIBFANCE TO NEAREST:WHl POLMOn ATION PFpRER1Y LIKE <br /> stOA►S ❑WDTH LENM_ DEPTH DISTANCE TO NEARE117:WELL FOUNDATION PROPEP"UNE 7TH <br /> DISPOSAL PONOS ❑WROTH LENUTH DEPTy LEST ANCE TO NEAREST;WELL FOUNbATION PROPERTY LNC <br /> I HERESY CERTIFY THAT I HAVE PREPARED TINA AIELICwTIDH NR THAI THE WORE VMI L RE DONE IN ACCORDANCE mTH SAH,�OAOLAN COUNTY ORDINANCES ANO STATE LAWS.AND/PMSG <br /> AND EGULATTOHO OF THE WAN JOAOLSNCGUNTY_ 1'1 OA LIC'NSEDAOENT-B SIGNATUE CEPTIPIES THEFOLLOVANO:-ICERTWYTHAT N TNEPRW-Q 1ANCE OFTHFVXM FORINNIICH ,� <br /> THIN PERMIT IB ISSUED,i SHALE NOT EMPLOY ANY PFREON CH A MANWA AS T I BECOME SURJ✓CT TO WORKMAN'S COMPENSATION LAWS OF CALWORNNA.- CONTRACTOR'S F47N0 OR <br /> SLIB•C N ATIME CE HE FOLLOWIFkI: I C IFY THAT RN THE PERFORMANCE OF THE WORK FOR VVWCH THIS P000117 IS ISSUED,1 SHALL EMPLOY PERSONS BURLECT TO <br /> MME'S CO PEN8 7RON F CAU IA.' THE PL1 NT MUST CALL ZA HOLMI IN ADVANCE PORNII���ALL REO•JRED NLSPECTLONS. COMPLETE DRAMME0 RIEELOW. �S <br /> NE.D% TOLE: <br /> IY L� <br /> R07 RAH IDRAW TO 11CA111 SCALE _Aro � <br /> 1, NAMES aF WIKE7B OR ROADS NEAREST TO OR..PLOT LHE IIIIIAW 711. A, LOCATION OF HOUSE BEWAGE DISPOSAL iYSTEM ORPROPOSED <br /> 7.OUTLINE OF THE PROPERTY-WITH OIM[NSIONa AHO NORTH DIRECTION. EIKPANSION OF a1WAGE DISPOSAL BYTTEMB. b <br /> 7. DIMENSIONED OUTLINES AND LOCAMN OF ALL EXISTNO AND PROPCRED STRUCTURES. S. LOCATION eP MUG W1THN RAOIUd OF ONE NUNORPD FIFTY FT,ON <br /> INCLUDING COVERED AREAS SLICH AW PATIOS,DTUVE!WAYS,AND WALKS, THE F"ArrY OR ADJOINING PnMPITY. ' <br /> - _ 'x/ <br /> 4 <br /> f� PlL'I. C '. s <br /> fes <br /> l.n . s• s• :_�-�- <br /> :CY. <br /> A; 4"1 e <br /> �,��fY' : . .Ara .,��,�. :. . .. .... . .l!... .. • :. . <br /> ..._ ....... <br /> _ .7 - <br /> ..r:•17.::1I;::?. .. <br /> 4 <br /> ':rsJL.IY <br /> 4ERVJCES <br /> �Viq-a <br /> ..,Ji9ENTAI_HE :,. <br /> FOR DEPARTMENT USE ONLY <br /> DATE: .9 1 tj 7 JCA/ 2� <br /> TAM.PFr OR BUMP NSPECTON BY <br /> t � OATT 1 I FINAL INSPECTION SY <br /> ADOPTIONAL C MMENTE: � `�'Y - /LJ a,o— K I A* <br /> jQ <br /> a+v,r9 S a v <br /> ACCOUNTWO O,LY- AIDE FACE <br /> PF CODE FEE INFO VNT RLARITFO CN[C ASH RECDVEO SY GATE RIP�MfT N[ALi9T WVOPC[I <br /> wJD,Hearth Sere,•EOWrO.Ela{3:96j <br />