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- S11rIOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 38F3, 304 EAST WEBER AVENUE, STOCKTON, CA 95291-W <br /> (209) 469 3420 <br /> 111011-REFUNDABLE PERMIT EXPIRES t YEAR FROM DATE ISSUED <br /> (Camplats in Tripliicatal <br /> TION 19 HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK OF <br /> fFFLICASCPoBED. THIS APPLK ATK)N I8 MADE IN OMPLIANCf WRH SAN <br /> Jp jCA COUNTY DEVELOPMENT TITLE,CHAPTER 9-11 10.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVfIRONMENTAL HEALTH DIVISION. <br /> CITY LOT SIZE , J - <br /> T C <br /> J08 ADORESSlOR AMT/ )l S (J � I ZC�+roNE <br /> ADDRESS <br /> — <br /> ONAMC <br /> 1 tic F'[10NE_-�_ <br /> DRESS <br /> CONTRACTOR l-�� [,HOS <br /> LK;f <br /> ADDRESS <br /> SUB CONTFLACTOR <br /> NEW INSTALLATION ❑ <br /> aEPalvwnanoN ❑ DESTRUCTION ❑ <br /> TYPE OF SEPTIC WORK: PETIC TEST 1•1( I HOW MANY_ <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) Apollowtion t <br /> INSTA"TION WILL SEFNE: RESIDENCE❑ COMMERCIAL. ❑ OTHER Cl <br /> NUMBER OF LIVING UMTS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> pITISUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> H <br /> CARACTER OF SOIL TO A DEPTH OF 3 FEET: 00 y 4 � NO-COMPARTMENTS_.__ <br /> [1TYPE/MF{i CAPACITY— / iC 1 <br /> SEPTIC TALNKA7LEASE TRAP FOUNDATION PROPERTY LINE <br /> PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL SAND OIL SEPARATOR(ENCLOSED SYSTEM) AL1 T\ <br /> DFT STATION❑ SIZE TYPE OF PUMP PROPERTY LINE �J <br /> �T I X T-7 S � DISTANCE TO NEAREST:WELL FOUNDATION <br /> LEAC"NO LINE a-Y NO.6 LENGTH Of LINER FOUNDATION PROPERTY LINE <br /> ❑WIDTH LENGTH DEPTH_DISTANCE TO NEAREST:WELL <br /> FILTER BED FOUNDATION PROPERTY LINE <br /> ❑WIDTH LENGTHDEPTH DISTANCE TO NEAREST:WELL <br /> MOUNDED FOUNDATION PROPERTY LINE <br /> a S_• SIZE ___NUMBER DISTANCE TO NEAREST:WELL <br /> SEEPAGE PITA DEPTH FOUNDATION PROPERTY LINE <br /> ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WETS <br /> st>ti1Ps PROPERTY LINE <br /> LENGTH <br /> DEPTH DISTANCE TO NEAREST:WELL FOUNDATION —�� <br /> DISPOSAL POl/08 ❑WAOTN <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN-THE FOLLOICE N COUNTY ORDINANCES AND 6TATE)AWS,AND RULES <br /> 'S SIGNATURE <br /> RTIFYT"AT IN THE <br /> AND��(T�IS SS OFT THE <br /> SAN <br /> NOQUMPLOV ANY PERSON IN <br /> EBTICH A MANNER ASR Oft LICENSED NTO BECOME SUBJECT TIOSWOWMAN'8 COMPENSATION LAWS OF CALIFORNIA.'CONTRACT R'8 Fort <br /> IRING OR <br /> IS TNI _ <br /> a WORKMAIT <br /> SU"orrTN COMPENSN TION LAW CALILFOFRMA.V11THE APMICTANT MUST CALL 4 HOURS IN ADVANCE FOR ALNCE OF THE V40M L REQUtRED INSPER WHICH THIS CTIONS)COMPLETE pftAVVINO BELOW SSUED.I SHALL EMPLOY NS SUBJECT T <br /> 4 DATE: <br /> TITLE: v�_— <br /> SIGNED% <br /> PLOT PIAN(DRAW TO SCALE)SCALE <br /> to <br /> !. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> T NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> FIFTY FT.ON <br /> S. LOCATION OF WELLS WITHIN RAMS OF ONE HUNDRED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. 6. <br /> PROPERTY OR ADJOINING pgppERTV. <br /> 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, <br /> INCLUDING COVERED AREAS SUCH A8 PATIOS,DRIVEWAYS,AND WALK <br /> .. e° - <br /> TI S � - <br /> c'lS1 ?opT.A. <br /> .mak <br /> Y, Y'M ENT <br /> M.A 191997 <br /> U _LI HE ;LIHi :ERVIGE. <br />