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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> v'NVHIONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 3011EAST WEBER•AVENUE, STOCKTON, CA"46ni- 8 <br /> (2091469-3420 <br /> NON•NEFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICm1IPMtB In Triplicate) <br /> APPLICATION IB HEREBY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANdOR INSTALL THE MW DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN <br /> AOURF COUNTY DEVELOPMEE�N�T^^TTELE.CHAPTER Nr-1110.3 AND THE STANDAROB OF BAN"ADM COUNTY PUBLIC HEALTH BERVICEB,ENVIRONMENTAL HEALTH DIVISION. <br /> ,a ADOREBBroR A/PNI r'Z� 130-5 Of �,i�.LYV, 0yf�i-(,"�'/� cm ��Y•ryN[1 LOT SIZE ,2(n /1�ZLEL <br /> OwN 8NAME 4,4714 le/L/LG1,'A ADDRESS 5? tce- f -1,� RIOW Z7-/ �J �� <br /> MMCTOR_ .✓--`�7TZy1 {//�+� AODREBB�Z� C - ��j[H(��% �Ji• �f+(: LOCI �'T'/ �7� RIONE x/103-5 X43 <br /> San <br /> WB CONTRACTOR AMMSB <br /> HC/ PHONE � `\ <br /> MOF OHMIC WORK: NEW INSTALLATION REPHw/ADd TION ❑ DFATn.cll.N ❑ <br /> tod SEPTIC SYSTEM PERMITTED IF I TILIC SEWER 19 AVAIIAOLE WNHM 200 FEET OF RIIIIdNo.) PRIC TUTIEI I I)IOW MANY <br /> ARpia Son F - l <br /> "'-TALIATION WILL BFRVE: RE9IOENCE COMMETIF:ML ❑ OTHER C1 <br /> MBd OF"NO UMTS:_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> R OF SOIL TO A DEPTH OF 0 FEET: 6 C PT/BV/M�p SOq CHARACTER TEP TABLE DEKH •1l <br /> EPIC TfNK1O1FASE TRAP ❑TYPE/MFO XI �7 �CMACIFY %ZF�J NO.COMPARTMENTS -A <br /> I TI TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL 1 F FOUNDATION L , PROPERFY LINE z;eIL7 F <br /> UFT STATION❑ SIZE TYPE OF PUMP SANG OIL SEPARATOR!ENCLOSED BYBTEMI <br /> LEACFINO UNE 10 NO.S LENGTH OF LINES IT'L/D'�•/(F'y DISTANCE TO NEAREST:YIEII 'le>-O FOUNDATION "10 F PROPERTY LINE <br /> "TER BFO ❑WOT11 LENGTH DEPTH _ DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> LONGED ❑WIDTH LENGTH OEM" DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY r• <br /> AYF➢AGE RTS DEPTH JS ' BRE 3FiTA NUMBERDIBTANCE TO NEAREST:WELL LRF FOUNDATION SO , P110PERFY ln1E ZGIGOY <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UME <br /> POSAL PONOS ❑MDTII LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE MW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,ANO RWE f <br /> AND MOUTATIONS OF THE 8•N"AMIN COUNTY.HOME OYAIER OR LICENSED AOEWB SIGNATURE CERTIFIES THE FOLLOWING:•I CERTIFYTHATINTHE PERFORMANCE OF THE WOR[FOR WNIC <br /> `-B PERMIT 19 ISSUED.1 FINALE NOTE OV ANY PERSON N SUCH A MANNER AS TO BECOME SUBJECT TO WOWMANT COMPENSATION LAWS OF CAUFORNIA.• CONTRACTOR'S MRNG On <br /> LCONTMC SIDNATUM CER FISH NE FOLLOV R 1 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IB ISSUED.I BHALL EMPLOY nR Ne SURJECT TO <br /> �fKMAN'B OM BA O F CA NT MUST CALL 24 MURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW.!/� 9 <br /> —NED% TITLE:_c",,A� DATE: 9, // F 7 <br /> POT PLAN IOMW TO SCALE)SCALE ,Ip �[•+ /�lrLLw <br /> v <br /> 1. NAMES of STREETS OR ROADS NEAREST TO OR ROUNDING THE PRIDPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SVBTM OR PHOPoSEG <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS ANO NORTH dMCTION. EXPANSION OF SEWAGE DISPOSAL BYBTEMB. <br /> DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS Of ONE HUNDRED FIFTY FT.ON <br /> WLUDIM COVERED AREAS SUCH AS PATIOS,DRVEWAYS,AND WAMS, THE PROPERTY OR ADJOINING PROPERTY. <br /> a YI <br /> s' <br /> I <br /> 2.0 AC,- <br /> &.-411 <br /> I ( 6-ute.a.FIEry I <br /> I 11 nr <br /> i <br /> c%P <br />