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f ' '4 JOAOUIN COUNTY PUBLIC HEALTH SERVICES ,. ENVIRONMENTAL HEALTH DIVISION `+ P,O. BOX 388, 904 EAST VVEBERAVENUE,STOCKTON,CA95207 88 1209) 466 3420 !• NON•REFUNDAKE PERMIT-EXPIRES I YEAR FROM DATE ISSUED s� � (Compute in Triplfaatal APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN ComWANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 0-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH13VISION. t14404 E. HIGHWAY 26, LINDEN, CA crtY LINDEN JOB ADDRESSIGR AFNo-i.'ossi;E 187 AE / I OWNER'S NAME FRANCIS GRUPE TRUST ADDRESS 14404 E. HIGHWAY 26 AISDNE93 ' '35$1 C NTRACTORWONG ENGINEERS. INC • ADDRESS 4578 FEATHER RIVERue# 14269 IINE476-0011 'SUB CONTRACTOR ADDRESS LIC# PHONE 4YPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDITION ❑ DESTRUCTION ❑ 11 3 IN SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) 7APoOmden TESTi.I t )HOW MANY tLMS-97-- 7 ii # ;INSTALLATION WILL SERVE: RESIDENCE 13 COMMERCIAL 13OTHER❑ - - - C> 'f -:NUMBER OF LIVING UNITS; NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 'CHARACTER OF SOIL'TO A DEPTH OF 3 FEET: PITISUMP BOIL CHARACTER: WATER TABLE DEPTH ¢ t SEPTIC TANKIGREASE TRAP ❑TYPEIMFG CAPACITY NO.COMPARTMENTS �i 'PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE. f$ LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR)ENCLOSED SVSTEMI . LEACMNQ LINE 13NO.6 LENGTH OF UNEB DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE `t FILTER BEDS ❑WIDTH LENGTH DEPTH !� DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE p MOUNDED ',� � 1 ❑WIDTH .LENGTH DEPTH L: DISTANCE TO NEAREST:WELL_____:_FOUNDATION PROPERTY LINE SEEPAGE PITS ❑DEPTH 812E NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE SUMPS E! 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE .4 DISPOSAL PONDS '� ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH DAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNERORurENSE4 AOENT'8 SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK fOR WHICH lf�} .THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUB-CONTRACTING SIONATURE CERTIFIES THE FOLLOWING:')CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL ILEGUIRED INSPECTIONS. COMPLETE DRAWING BELOW. �! - C. CIVIL ENGINEER 12--17-97 SIGNED X ! TITLE: DATE: 71 3 y PLOT PLAN(DRAW TO SCALE)SCALE "to I."NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LO I OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2J OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPM�t=INO IBPOSAL SYSTEMS. 3.`DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LHIN RADIUS OF ONE HUNDRED FIFTY FT.ON IiNCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. T PROPERTY. _ ...,., ..... ... V Er D19 ?997 u.: i w 'w SANJOAQuI i PfJ81 JC N Couhrry b^ a�FWViRONWW, IHEAESERVICES _- Lj )nl Z3M1UN3A V1*WLutlt ' r51�$`70 1 so- : d N l fuN"1 2ci E agFz e+ cI y� fix} 3t at a<� oN a Abj3 Wn �' Mae�21 lintll 7dnah � I � u g � � 5 iE f Y6 x 'W 7M[lYtl3d0 ro7 Si1:l YiSAtll V1ryM 7d [17OA ': IN 7�fOlOM wri Sr' �1M] Ar1433.1 ".r 7�nY9 ariw 77Y� f : FOR DEPARTMENT USE ONLY •:, e APPLICATION ACCEPTED BY DATE: L it AREA: 7�1 � tl TANK,PIT OR SUMP INSPECTIO14 BY DATE I / FINAL INSPECTION BY - DATE l ( a ADDITIONAL COMMENTS; rACCOUNTING ONLY: AID# FACE :F I�PE COPE 11 FEE INFO AMOUNT:REMIITED CHECK# ABH RECEIVED BY DATE SR I I ERIA T NURIBEIR INVOICE# D 3 !z l9 U V-50 J Pub.Health Serv.-Enviro.174(3196)