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i CPPPUCATION FOR UQUll)WASTE PERMIT 4 SAOAQUIN COUNTY PUBLIC HEALTH S ACES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON, CA 55202 f F (209)4683420 RON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED R% "hots be TripRplhl APPLICATION IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN ' .JOAOUIN COUNTY DEVELOPMENT TITLE.CHAPTER 8.11 i0.3 AND THE STAND OF A COUNTY PUBLIC HEALTH EB, AL HEALTH DWIBION. ,I�. ri-L �[/f��C LOT 812E/-' XeA - JOB ADORESS/OR APNI „�� /� � � �/�.. �OWNER'B NAM 1 -M4 ADDRESS + -j/+Ty^'�Y�`'"�- cam / PHONE �Q F' (CONTRACTOR 1290N `�- ADDRESS { l �-+ •'l/ !� LIC/PHONE - �� am CONTRACTOR -ADORES B uCi PHONE f TYPE OF SEPTIC WOW: NEW INSTALLAT)ON REPAI(ADDITION ❑ DESTRUCTION❑ IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AV tE WITHIN 200 FEET OF BUILDING.) Y'ERC TESTbI I IN"MANY 1 APPIo�Son i INSTALLATION WILL SERVE-- RESIDENC COMMERCIAL❑ OTHER❑ 44 'NUMBER OF'LrvmQ UNITS:�L N OF BEOTIOMW: 73 NIMN'681 OF EMPLOYEES: / L 1 OF SOIL TDA DEPTH OF 3 FEET: au.-I PlTX"SOIL CHARACTER: ,,..A WATER TABLE DEPTH ! T OEYIIC T E TRAP .1]TYPE/MFGC . 1JTN� CAPACITY l L2 20 - NO.COMPARTMENTS CZA PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL 0 r f FOUNDATION PROPERTY LIFT STATION❑ SME TYPE OF PUMP SAND OIL SEPARATOR!ENCLOSED SYSTEMI NMI UNE NO.i LENGTH OF LINES A'I�o �, 2-DISTANCE TO NEAREBT:WELT 5� FOUNDATION y� PROPERTY 11NE `FILTER MED 13WIDTTT LENGTH - DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LANE MOUNDED 13 WROTH LENGTH DEPTH DISTANCE TO NEAREST:YYELL FOUNOATIOk PROPERTY UNE SEEPAGE PTS ❑DEPTH 812E NUMBER DISTANCE To NEAREST:YUET.L . FOUNDATION PROPERTY LINE BUMPS. : ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WT1L FOLNNOAT" PROPERTY LINE DIsPDSAE PONDS ❑WIDTN LENGTH DtVrH DIB'TANCE TO NEARESTS WELL FOUNDATION PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED TMS APPLICATION AND THAT E WORK WILL BE DONE IN ACCORDANCE WITH SAN JOACIM COUNTY ORDINANCES AND STATE LAWS.AND RULES �ANDREGULATTDNSOFTHESANJOAGI1NC OWN LJC AGENT"SSWWATURECERTIFIESYHEFOLLOWNNG.'ICETTIFYTHATINTHEPERTORMANCEOFTHEWORKFORWMCH TH1/PERMIT ,I B,IALL NOT EMPL ANY N M SUCH A AS TO BECOME BUBJEC'T TO WD AM N'S COMPENBATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB.CO NG TF)ES FOLLOW .h CERTIFY T IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM IS ISSUED.1 SHAM EMPLOY PERSONS SUBJECT TO WORKMAN'S COMM T /l' 2L HOURS IN ADVANCE FOR ALL INsmvONs. COMPLETE DW►WING SELOW. 2 9cp 8X)HED X TITLE DATE: ✓ V\m PLOT PLAN)DRAW To sCALE1 SCALE 'Re 1. NAMES OF STREETS OR ROADS T R BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED F2. OUTLINE OF THE PROPERTY.WNH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAOE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, s. LOCATION OF WE1Li WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS.ONVEWAY8,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. ., - - -- .., ................ .... .. - - ... . .. .. �. : ..... .:......... :......:.......:. .....:.......... .......':.....:... : .. . :. .. ....... '.... .. .. .. ... ............ _._...........: .......... .. . .. ............. ..C.,k� . .. ... ........................................... .............. ............. ............. ...... . ...... ........................ . ............... .....{ .......... ...... .......... .... ...... ........... ....... ............. ........r. ....... . ..... ............ ....................... . ... �._............... ;.. `.. .