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SAN JOA1IUIN COUNTY PUBLIC HEALTH SERVICES <br /> 'Iu ENVIRONMENTAL HEALTH DIVISION <br /> iI <br /> P.O. BOX 38E1,-304 EAST WEBER AVENUE, STOCKTON, C 4'SMi3N 3. <br /> 120914683420 <br /> NDN-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> I. Momp11b In Tripr"tol <br /> APPUCATIdI m IRPEBY MADE TO THE BIW MAOUN CJNUNFY FOR A PERMIT TO CONSTRUCT ANDRIR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WITH BAN <br /> bAdUBECOVMYDEVEDPMF T/MLCH�A/��FER9-1110.3 AAN/DTNE BT BIDS <br /> OF SAN"AWN CoUf MOM HEALTH SERVICES,ENVIROWEIRTM.HEALTH DIVISION. <br /> _RHI ADDRESSIMR APN//tj 1W1 ( 41-LILA0-1-0{yC. �Z4AA61LLOT,� �F1_ � ADDREss IU -1 70//1Q PIgNE]rF'7_7d`✓ -�ili� <br /> CONTRACTOR �'r NI 'C <br /> ADDRESS IICI PHONE <br /> I�6TUBCONTINCTM ADDRESS IR:I PHONE <br /> - <br /> TYPE OF SEPTIC WORK: NEW NATALUITION REPIW VADDIT10N ❑ DFITRUCTION❑ <br /> NO SEPTIC SYSTEM KnMIMD IF PUBLIC SEWER IS AV IU ABU WITHIN 200 FEET OF BUILDING J PER:71011 1 NOW MANY <br /> Apoll-B I <br /> INSTALLATION WILL SEINE RESIDENCE❑ COMMERCIAL ❑ OTHER❑ <br /> NUMBER OF LIVING UMTS:_ NUMBER OF BEDROO _ NUMBER OF EMKOVEES: <br /> CHARACTER OF SOK TO A DEPTH OFI�3FEET: F'� PR P SOIL CHARACTER: II WATER TABU DEPTH / <br /> SEPTICTANIUSREASE TRAP J9TYPEXIM L CAPACITY:42Q r W.COMPARTMEWB <br /> MO TREATMENT PANT 11DISTANCE TO NEAREST: WELL FOUNDATKIN PIIOPERTV UNE / <br /> LIFT STATION❑ SITE TYPEOF RUMPr`` SAND <br /> OIL <br /> SEPARATOR REMLOSED 9Y9TFM) n <br /> -LEACHING UNE NO.a LENGTH OF UNEB �C T !�D/�/ DISTANCE TO NEAREST:WELL VNDATRIN E��I�RTY,,, <br /> FILTER BED ❑WIDTH 11]lOTH DEPM DISTANCE TO NEAREST:WELL FOUNDATION RROPEFR 'LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LRJE <br /> SEEPAGE RTS ❑DEPTH MSE NUMBER DISTANCE TO NEAREST:WELLMUMIATION RIoPERFY UNE <br /> SUM" ❑WIDTH LENGTH OEPFH DISTANCE TO NEAREST:WELLFOUNDATION PRDFERFY LINE <br /> DISFOSAL PONDS ❑WIDTH LENGTH DEPTHDISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TH19 APFLR MN ANO THAT THE WORE WILL BE DONE N ACCORDANCE V H SAN JOAOUIN COUNTY ORDINANLE9 AND STATE LAWS.AND R 9 <br /> ANO PEOIKAT B FT1- <br /> E BAN JOAOUIN COUNTY. EOWHER OR LICENSED AGENT'S SIGNATURE CERTNES THE MMCO NO:'I CERTIFY THAT N THE PERFORMANCE OF THEWORL FOR WHICH <br /> THIS PERMIT 13185 ED.1 SHALL NOT EMROV ANY N IN SUCH A MANNER AS TO BECOME SUBJECT TO""MAN'S COMPENSATION LAWS OF CAUFORMA.' CONTRACTOR'S HIRING OR <br /> PER <br /> SUBLONFIUCTI 51GNATUPE CERTIFIES LIE FOLLOWIU D:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT 18 ISSUED.1 WALL EMPLOY PEfl60N8 SUBJECT TO <br /> WORLM '8 CO =A ION EAWS OF AUFORNIA' E APPLICANT MOST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMREFE DRAWING BELOW. <br /> z. �F4 ' <br /> SIGNS %1 44 YRLE�� DATE: <br /> MOT RAN IOBAW TO MALE)SCALE *I^ <br /> 1. N E8 OF STREETS OR IIOADS NEAREST TO OR BOUN09I0 THE PROPERF V. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR RgPoSED <br /> 2. OUTLINE OF THE PROPERTY,WITH D1MEN RON8 AND NORM DIRECTION. EXPANSION OF SEWAGE d9FOSAL SYSTEMS. <br /> 3. DIMENSIONED OURNES AND LOCATION OF ALL EXISTNRi AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNdED TUFTY FT.ON <br /> NLLU COVEPED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS-J THE PROPERTY OR ADJOIHNO P11DPERfY 1.....:...... <br /> v <br /> z <br /> - ` a fir Tot <br /> !�6� t <br /> --------------- <br /> PAYMEiVT_ v..... <br /> RECE1V . <br /> '3 JUN 23 1997 . .... <br /> --- PUBUG HEALTH SERVICES <br /> 4 ,. r�/ ���� v�/�J ENVl80NMENTALH6LTHOIVIS <br />