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3e SQA S�� SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION - <br /> -(`j° <br /> P.O. BOX 98904 EAST WEBEFi'AVENUE, STOCKTON, <br /> 1209) 488-3410 <br /> WOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ... (CBmplatB in TT$IiBBtal <br /> APRICATION IS HEREBY MADE TO THE SAN JOAOUIN COUNTY FOR A FEWET TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS API ICATION 18 MADE IN COMMIANCE WITH SAN <br /> ,AOIAN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1``110.3 AND THE STANDARDS OF BAN JOA011W COU RIMIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> /I/Jl+L 15(144 /SLY— A40Vr� �JJ� / CITY .F�/� LOT <br /> jSIIZEn;&OW <br /> ` JOB AIXNIEBSAR A�PN7.)/.w� ADDRESS F d Ij 7 YAt B�C A <br /> RW,m6R'a NAME r/AM� NL /�E �L� <br /> CONTRACTOR / YNR ADDRESS M' RIONE <br /> SUB CONTRACTOR <br /> ADDRESS LICE RIONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 16EPASUADDITION ❑ DESTRUCTION❑ <br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN POO FEET OF BUILDING.) l91C TESTER I 1 NOW MANY <br /> ApPE6ASoe 8 <br /> IN6TAIUDON WILL MIRvE: RESIDENCE❑ COMMERCIAL❑ OTHER ❑ <br /> NUMBER OF WINO UNITS:,_ NUMBER OF BED/ROOM : NUMa61 OF EMPLOYEES: <br /> _ CHARACTER OF SOIL TO A GERM OF1yJ FEET: F" RT P SOIL CHARACTER: �t WATER TABLE DEPTH <br /> SEPTIC TANKIGMASE TRAP ATY'FEIMFG L CAPACITY U M.COMPARTMENTS <br /> PKO TREATMENT PLANT❑ pMTANCE TO NFME6T: WELL <br /> FOUNDATIONS PROPERTY UNE / <br /> LIFT STATION❑ SIZE TYPE OF PUMP /SAND OR 6EPAMTOR(ENCLOSED SYSTEM) <br /> LEACRMG UNE NO.B LLNOTN OF UNEB$/L- _DISTANCE TO NEAREST:WELL ^ UNORIONRORRtY LINE/ <br /> FILTER BED ❑WIDTH LENGTH DEPTH_ DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEP EI DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE RTS ❑DEPTH BRE NUMBER DISTANCE TO MEANEST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS ❑W,,TH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATRIN FROPEBTII UNE <br /> DISPOSAL PONDS ❑WIDTH LLMTN DEPTH DISTANCE TO NEARE8':WELL FOUNDATION PROPERTY LINE <br /> _ 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS ATTIICATgN ANO THAT THE WOTE(HALL BE DONE IN ACCORDANCE WITH SAN JOAWIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ANDREOULATIO S FTHESANJOAWINCOUNTY._ MEOWNERORUCENMOAOEW,GWGNATUMCEWIFMSTHEFOLLOWINO:'ICERTIFYTHAT IN THE RiFORMANCE OF TIRE WOTK FOR WHICH <br /> THIS PERMIT IS 186 ED,1 SHALL NOT EMPLOY ANY N IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTORS NIRNO OR <br /> SUB-CONTRALTI SIGNATURE CERTIFIES THE FOLLOW( :'I CERTIFY THAT INTER!PENEORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECTED <br /> N'ORKMAI!'8 CO NBATgN LAWS OF ALIFORMA.' T APPLICANT MUST CALL 34 HOURS IN ADVANCE FAR ALL <br /> REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. <br /> TRLEY/UI��„ DATE: ��?s <br /> SONE X <br /> PLOT PLAN MRAW TO SCALEI SCALE 'to <br /> !. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> _ 1. N F8 OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> E. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> LL <br /> 3. DIMENSIONEO OUTLINES AND LOCATION OF AEXISTING AND PROFUSED STRUCTURES, THE RAOMRTY OR ADJOINING PROPERTY. <br /> INCLUDI COVERED A S°UCH AS PATIOS•DWVEWAYS•AND WM o' _ <br /> a �( -4- <br /> too <br /> o � r N i � ,•a��r rte_ , ��P ;c,T�}n1 2 <br /> >< <br /> 6a5� <br /> a PAYMENT <br /> 3 JUN 2 3 1997 <br /> --- -�' PUBLIC.HEALTHSERVICES' <br /> �r�� .FI v. n ENVIRONMENTAL HEALTH DIVISION <br /> X094.7 �nJ /` <br /> T So/,Lh+ <br />