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SAN JOAQUIN COUNTY RURLIC HEALTH SERVICES <br /> Fr ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 38&304 EAST VVEBER AWMLIE,MCKTON,CA 95201588 <br /> (203)4833420 <br /> MOM REFUNDABLE PERM EXPIRES 1 YEAR FROM DATE ISSUED <br /> M:AMNIDIO IS TF41IOMI <br /> APPLICATION IS HEREBY MAGE TO THE BAN JOAOFN COUMY FOO A PEW'AO TO Ca,NHLT AHOA,N INSTALL INE WOW(OESCWBw.THIS AP ATNIN Ia MADE M COMFUNJCE OATH 8AN <br /> mAWIN COUNTY OEYELOFNEM TOLE <br /> ma ApGREeeron ,.AFT.9.11 ljp.3.THE ST.AOOF SAN m.IAN CT"VNEALTX CSEO0. M <br /> 3671 SgWMON.T <br /> Wss_ <br /> 10 <br /> DWNM9 NMRg9 9r, 1 /sy <br /> l p0 <br /> WNTOFQa /1a -A7:FJ/9 <br /> BUN CONTNCT. AOpaEaS LN:. PXOHF 3b7-ctla <br /> TYPE OF SOTIC WORA: NEW MIST...E3 FWAINIAONOIOM 06TRVCTMN❑ <br /> qV SEPTIC SYSTEM RNMTI ED IF RIMIC NFOAFt 19 AVNIANLE WOHIN 2M FFFT OF O uFOMG.1 FML TEATNI I 1 NINE MNIY <br /> N NNNSI C <br /> IXFTAILAIbM WILL SONE RF.I,E ET COMMERCWL❑ I.E.❑ <br /> NtM0N1 OF ONHO..T.: 2. NMNBM Ci BFgI00M0: NUAIOM OF MAPIOYEtl: F <br /> CN OF SOIL TO A OFPn1 OFF 3 FEET: MANINIF SON. <br /> .IbIlAP�ACTER: Q WATM TANTE mFT, gr, <br /> ABTIC TTM FANS T,PM pa,rFFMC�FE c itLMACOY NO.CDM.ANTMENT. � 1 <br /> FAO EM PVINO DISTANCE TO NFAPgT: WELL /GIFT POVNOATION PROFEOTY UNE Ll) <br /> UR STATION❑ BIII�� ,Q�T1;.F 9AN0 DR 6[FARATOR IE WOSD WSIFMI <br /> IEACMMD YNE ❑ NO.YI£NST.OF LINEN (�[ i�i0� McIANCETO NEAP.[BT:WELLJOo OVNOATMH X0 ',-r <br /> HIT.A. ❑WOTM LENOTH_,,o@!RDHlN VKVW OISTANCETON.l:WU{,dffljW FOUNDAIIONjIllir PNO99OY UNE <br /> MOVMpM ❑..tH �L... IS". DISTANCE TO NEAOEfiT:WEIl FOVNOATS.11 PEIRY UNE �T c <br /> SFEPAOE PRS ❑OEFTH ey�G� SIZE __NUNNM�/�-_gSTANCETO NEAOEBT:N4LJf�jffywVNOATMN.��P0.0 FEMt'UNE ZSr/ V <br /> B ❑..TH�jJ_IEHGTH DEIN r g6TMILE TO WAREST:SWu- OUNDA.N�PWFEOTY UNE <br /> DISPOSAL pXpS ❑W1MN IENOTN DFP[4 OISTANCE TO NEARF9T:Wel_FOONDATWN_FFOPEOTY LINE <br /> 1 HERMY CERTIFY THAT 1 HAVE PREPAOw THIS ANON NN THAT THE WOF%WILL K DONE Ix ACCOMANCE SAT.SAN JGAWIN COVHTY..NANCEN ANO STATE LAW..ANO FVLE9 <br /> ANO PEOVlAT10NB OF TXE SAN MAWMCOIJNTY.HOMEOW11M00.UCEN9EO AGENT'.MONATVRECERTFINS THE FOLLOWING:'ICEMIFV THAT W THERMOFMANCE OF THE mW.PoR WINCH <br /> TRIO RRMIT 1616 VMIB AICxOT EAgDV AHV WibONM011CHAMANNFA AO TO BECOME BVB RCTM WO1KMl�N'N COMF4N6ATN)N lAW00F CAUFOFNIA.' COMPALIOR'SHFFNO OR <br /> BVNCONTMCTI FfldlA FF CERTMESTM FgIDVNA:'I CHITTY TNATMTHE PEMONAMKE OFTHE WOM FOn WMOX TNIB PFAMN101.511w.I6NALL EMWOY FTn60N.SUBJECT TO <br /> WpN(MAN' [ PFNBA� IIAWSMCNIPDWAA.'1W APNCMITMWT CKLMNOWN WAWANCE F�O/0.f ANLL II�EONfP®.IN�SP'KTbTM. COMPIFTE ORRIMHO'.EELOW. <br /> gGNw% •....•. A TTE:���1 '�•�F"A pRTE: J 3 <br /> e <br /> ROT WAN MIAW TO SCKEI BLAI£ e <br /> 1. NAMES OF 6TNEFT6 pO WAGS NEAIIEST TO OO aOUIDHJA TM ROPEOIY. •T<.LOCATOR OF XOU6E GE pI8PO5AL SYSTEM OR HOPo9E0 <br /> S.OIRIYVE OF TXE FPOPEIITY.WITX gMEN310H0 AND NOIfTN pIFECTON. E%PANBION OF SEWAGE O9W SAL <br /> ON <br /> 6Y.TE <br /> 9. O1MEH610Nw OIRLIHEO PND LOCATION OF ALL E%ISnNG A110 PW W6COSIWICTUIEO. LPTON OF WELL.WOHIN MONK OF ONE NVNDWG HFTY IT.ON <br /> INLWDIHIi COVERED AREAS.LILY P6 PATIOS,pP1 VEWAYS.ANO WAII(8. a THF.FWPERTY On ADJOI TNG PROPERTY. <br /> oc <br /> I <br /> a <br /> S <br /> ` G y <br /> l <br /> t <br /> :. sem.:... <br /> 70.,.._ FOR D®MTNO,l1.1 <br /> ARLC//AT''I��ONA 010 3V \_./ YI Rr' DATE' a, AP JH <br /> .UMP INSPECTION BY �1W4 DINT. Z l l I FINALINSPECTWNBY WlS ICS <br /> 'MgFSHI LCOMMENT.: <br /> X41J- I r_, 4-- <br /> AuouxnxG orrtr: AIw FACN <br /> Pf CDOE AMOUXT RPAI11. CI. TAS. PRUVm CY 1 DATE SRIPBWFTNIANBM INVOIC[/ <br /> I R <br /> L` Pub,HeaAb Se,-Envira.174(3/96) <br />