Laserfiche WebLink
SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION INSPECTED BUT NO-r <br /> P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201388 SIGNW <br /> (2091 469-3420 ' <br /> NON-REFURDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Triplieetel <br /> APPLICATION 18 HEREBY MADE TO THE SAN JOAGUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOR(DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STyA/.HOARDS OF BAN AOUIN COUNTY PUBLIC HEALTH SER/V��(mEB,ENV111T)pNMENTAL HEALTH DIVISION. �%�} / <br /> JOB ADDRESSOR APNI\\,, -- / IzTj�r (/ I P YI 1 Y /�� n J,//� (/C'ITY LI`LA• // LOT 81ZE l e/1"(/i <br /> OWNER'S NAME C(Yl lJlSz✓l ADDRESS / •//(%L•�' 36 L4/&A GJ. "I69-�RONE 9W S71S^�9 <br /> CONTRACTOR '''"'TTTFFF������ L / ADDRESS L1CI BONE <br /> SUB CONTRACTOR /r ADDRESS DCI RHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATNIN ❑ REPARVAUNTION ❑ DESTRUCTION <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) '�jy,�i, PERC TESTI)I I IOW MANY <br /> I �✓ I/ APpIo.Bon <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL ❑ OTHER ❑ <br /> v /NUMBER OF WINO UNITS: NUMBER OF BEDPODM6: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> SEPTIC TANKMtFASE TRAP ❑TYRJNIFG CAPACITY M.COMPARFMENTB <br /> WO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACHING UNE ❑ NO.A LENGTH OF LINES DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY TINE <br /> FILTER SED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY ME <br /> SEEPAGE PRS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELLFOUNDATION RIOPERTYLINE <br /> SUMPS (I MDT" LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PRDPERTYLINE <br /> DISPOSAL PONDS ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN"AMIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN"AMIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THATINTHEFEMORMANCEOFTHEWOTKFORWHOH <br /> THIS PERMIT 18 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME 9UB IECT TO WOIKMAN'8 COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIM"OR <br /> SDS,CONTNAMND SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO <br /> WOIKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THIS APPLICANT AMUST <br /> /C{A/LL/�2S HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. �(/�/ <br /> SIGNED X /- — / TITLE: �•LO/F;7�1' i� DATE:�y� <br /> PLOT MN ID TO TO SCALE(SCALE_'to / <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE R/OPERTY. 4. LOCATON OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTUNE OF THE ROPERTY,WITH DIMENSIONS AND NORTH DIREI�LTTON. EXPANSION OF$MADE DISPOSAL SYSTEMS. <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 COWRED AREAS SUCH AS PATIOS,OPIWWAYB,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> Rc <br /> L19ERTY <br /> MA6KVILLE 961 TPT <br /> RLO_AV `p�I <br /> Z I J <br /> J } <br /> Taw <br /> F -¢ EL I O <br /> `♦tel. UI FR OS-�LOT LINE <br /> ZO I \1 <br /> z �LI <br /> IX to INSPEC�+T •DSUTNOT <br /> 4 PA�EL.� IW I SI NED <br /> N , <br /> I IW < h <br /> LFXISTINS LOT LINE <br /> k <br /> a ; <br /> ��. CHE ,! , <br />