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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER•AVENUE,STOCKTON,CA 96201368 <br /> (209)401.3420 <br /> 1109REFURDADLE FEAMIT EXPIRE$LYEAR FROM DATE ISSUED <br /> 16.R■Pl.l.4 7.4intb) <br /> APPLICATION IS H04AY MADE 70 THE SAN JOADIJIN COUNTY FOR A PERMIT TO CONSTRUCT AN VOR INSTALL THE WORK DESCRIBED.TIB APPLICATION IS MADE M DOKLLANCE WTTA SUHN <br /> JOADUIN COUNTY D[VELOF%AENT TITLE,CNAmn X9.1 1 10.3 ANU TTHHEE�6-FrNjID:IJOS SAN JOAOiM LINTY PUM1C WEALTH SERVICES. <br /> DEMINlOM.gRK/EAL.TH DIVISION. <br /> JOS AOIMESNORAPN, V 7Q (/," G'✓�C/�S/�/`�<y� �J _CITY /1VA LOT Ian-l��7 <br /> S ' <br /> OWK"I'S NAME97 �'�'� ADDRESS /T PHONE !;Ll-4"j •7�/ <br /> T7 _/ <br /> OGNTRADTDR .../Z'Iv�*`�PL �"aG ALMIRE99�zy L/fF�V/�'•� C- SAL UCO <br /> un6 le `F RIO- 68y� <br /> SUS <br /> CONTRACT 011 ADDRESS Oct RIO.I, <br /> TM OF 4EFTIC WONT: NEW INSTALLATION❑ NFPNNAN]OTION OESTIIUCTIDIR❑ <br /> DIO SEPTIC SYSTEM ITHMTITLDIF PUBLIC SEINER IS AVAIARLE WITHIN 200 FEET OF SU INCA —TSSTI.)I I IID'W MANY <br /> AFPSWPn P <br /> INSTALLATION VAIU.SEIVL RESIDEIK.E W COMMEPCML❑ OTHF14❑ <br /> NLIAEML OF LIVING UMTS:-_L Mw.M61 OF SEOROOM4�NUILISEL OF EMPLOYEES. / <br /> C ly/�T1�)OF BOI TOA DEPTH OF 3 FEET: Mil.' PITIStcJMP SOL CHARACTER: / WATER TABU DEPTH <br /> TSil71C VA4ASi TNA. D,YI'ENYYI -,J.C'GC( DAPACRY /lD� NO.CDAiNRT►ENT111 <br /> FNA TREATMENT RANT❑ DISTANCE TO NEAREST: WELL O FOUNDATION t'O � PRDKRW INE <br /> LIFT STATION❑ 6I2E TYPE OF PUMP SAM OI SEPARATOR IENCLOSED SYSTEMA <br /> LEACHING UNE pNO.\lF1NOTH OF LINES 14 /.itB C*STANCE TO NEAREST:WELLS_FOVNOAiIOF:L�FIIDRRTY LINE S <br /> FITEI Sm ❑wwrH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOLIAATFJN PROFEWY UNE <br /> MOUNDIM Cl WIDTH LENGTH_ DEPTH OIHTANCE TO NEAIE'ST:WELL FOUNDA.FION PROPERTY LINE <br /> SAGE PLTS 0 DEPTH S / S12EC�JF�MNASER_Q&_DISTANCE TO NEAREST:wRl�POVMJATION/O / RWFERTY UNE S / <br /> SNAPS ❑WIDTH LENGTH _DEPTH DISTANCE TO NEAREST:WELL FDIAVOATION PFAPDRTY LINE <br /> W <br /> OUPOPONOS 11~71 LENGTH__OEPrN DRSTAOE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> I HELEA`/CETIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WRl1 R:DONE N ACCORDANCE WHIN SAN JOAOUN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> NA140ARATION.OFTHIE SAN JOAOUNCOUNiY.SOME 0M4NEROR AOlNT'SNONATNE CERTFRS TIE FOLL.OWl10+I CERTIFY THAT N THE PERFORAA4CE OF THE WOW FORWMCH - <br /> THIS ISSUED•I HOT PERSON N SUCH M TO BECOME HUb.IECT 70 WORRUAWS CCNKTMAMN LAWS OF CALIFORNIA.'CONTRACTOR'S HIRING OIL <br /> SU f1AC O UU TU C B Tl1E LLOWWO:'1 CETT T T N THE PEFFORMANCE OF TIE MARL FOR WHICH THIS PERMIT R 19"0,1 SHALL EMPLOY PERSONS SUWWr TO <br /> WOFKMAN'S CO TION CALIF TSM T'CIOL 74 HOURS IN ADVANCE FOR ALLLL,F,R000NEI INSFBCTIONS. COMPLETE DRAWING BELOW. <br /> TITLE:�t,4I DATE: I^ lZ g <br /> ROT PLAN/DRAW TO SCALES SCAM _*u <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DMIOSAL BYSTEJ OR PROPOSED �© <br /> 2.OUTNE OF THE PROPERTY.WITH 0"0400146 AND NORTH DRECTION, EXPANSION OF SEWAGE DYPOSAL Il'STE..S. v <br /> J.DIMENSIONED OUTLINES AND LOCATION OF ALL EXIST"AND PROPOSED STRUCTURES, E.LOCATION OF WELLS WITHIN RA"OF ONE HUNDRED FRAY FT.ON <br /> NCLUDIPM 00%41® RE <br /> AAS SUCH AS PATIOS DRIVEWAYS•AND <br /> WALKS. C rf THE PIIDPERtt OR ADJOINING PROPEIEY. }F_ <br /> w. <br /> .. ...:...... . 3�p • <br /> 64 <br /> I <br /> k .... <br /> �s <br /> Salk <br /> :Ja '. <br /> 4,4­ <br /> .. <br /> AYMEW.... <br /> E.1iED:. ...............:...... <br /> :._.. <br /> • J+ r w SOW JG N C UNTif ... . <br /> IOL. r . ..... A <br /> UITl1CH1fNSEiMliCLe.._ .... <br /> I <. .. ....,... .. REREUE001l s MI.H&ALTFEOPII SN <br /> FOR DVARTMEIT LME ONLY <br /> APPLICATION ACCEPTED BY DATE A( l ALRFAt Z •L4-(3 <br /> TAM ELT OR BLIMP NWECTAryN N.NMEC <br /> FITIGN s'f��+-�•�''�� L7Al'E R A``F I <br /> PLMMTIINlAL COMAENTc. / .Z 7 1"F--c..R .Ilr of 'h 1-f,f /4..... 'r-/rte••L//.4 - !�A 9l- AA--.,-)--h 4 w r4*114 old'f _N�4Pn.L7i�r�,r„r/ <br /> CPrr,el+ 0 rAl. (• //S 1—y-t/O /'It CxI ,C'AaI.+4cyT /L t <br /> ACLMUNTINO ON6Y: NIDI FAC. n.o PE.3 .{ey.aM1 ��1 91LlrLd GEO <br /> PE CODE FEE NFO AAOVNT REM I TED /RRC ICA I. REL HUED.Y DATE -1 PERST NUMSEA INVOEOEP <br /> lO f ou3 <br /> ITI:b.HN1Mfi SBrv.-Emlm,174(3195) 74 <br />