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014" JUA`UUI111bUUIII I rUOLIU MCRLIMof VItto ENVIRONMENTAL HEALTH IIIVISION ' P.0 ""X 388, 446 N.SAN JOAQUIN ST., STOCKTON,CA 96201.0?a° (209;468.3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) M".ICATION IS HERCBY MADE TO THE SAN JOAQ IN COUNTY FOR A PERMIT TO CONSTRUCT AND.OR INSTALL IHE WORK DESCRRLD 71416 APEICATION 16 MADE IN COMPLIANCE WITH SAN JOAOUIN COUNTY DEVELOPMENT TITLE, J CHAPTER Ig[11��,111_0..3 A.NtD^'THE ST ANDAROS OF SAN JOAOUIN COUNTY PUBLIC MFALTII or RV1Cf S,r"NVIRO.N..+MFNT AL HEALTH[XVISION. JOB ADDNCSSIO IF C I J 1 V• '�'[,",�/I l'tE.+�) �Q�1 C� ,L CITY �C.C�w�•1.1�[l LOT SIZE��-FJ-.. OWNER'S NAME )� LLLDILQ AOOR[SS_�E�[(11G^+A Oz,( �l//(�• a� PHONE3(.b'(•J`1323 [� CONTWICTOl tt lV'{ tif� I.i. AUORf Fi -I,F7 LIC/�Z�/LZ�' p110NE 3LJ 1O� BUB CONTRACTOR ADUACF.i UC/ F440NF TYPE OF SLI-TIC WORK. NEW INSTALLATION❑ IIEPAIIVADDITION TF WISTI CTiON ❑ If+F.SEPTIC SYSTEM PEWARTEO IF PUBLIC SEWER 18 AVAILABLC WITHIN 200 FEET OF BUILDING.I POW TFATI/1 I 1 FLOW MANY _ ��/ I ADP6AotloR INSTALLATION WILL SERVE: RESIDENCE EO COMMERCIAL❑ OTHER❑ NUM6ER OF LIVING UNITS, I NUMSM F BEOROOMS:�_NUMBER OF EMPLOYEE{- __ F CHARACTER OF SCTO A DEPTH OF J FC[T' _.V�'-`-�•�.d�-PITUyP SOIL C//ARACTFR�. WATER TABLE OF.PTN�� PAP 13EPTIC TANK10RL1SE TRTVKWFO CAPACITY NO.COMPARTMENTS ►KG'REATMENr PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION MgPERTY ONE _• LIFT STATION❑�.S/IZE TYPE OF PUMP /_-r,_SAND DIL SEPARATOR IENCIOSCD SYSTEMI 4 LFACHN[.UNE FANO.A LENGTH OF IJKS_l—y Q DISTANCE TO NEAREST:WELL FOUNDATION IO} PROPERTY LINE S FILTER BED /❑WIOTII LENGTH DEPTH__DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY UNE MOUNDED ❑WIDTH LENGTH_Tr DEPTH DISTANCE TO NEAREST:WELL FUVNOATIONPROPERTY UNE / SWA4v MTB DEPTH _SIZE _NUMBER_DISTANCE TO NEAREST:WELL• 0() 1 FOUNDATION 1 O 4 ROP1RTY UNE_ V l SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNC DISPOSAL PONDS ❑WIDTH LENGTH _DEPTH DISTANCE TO NEAREST:WELL FOUNDATION _PROPERTY UNE ` 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAGUIN COUNTY ORDINANCEB AND STATE LAWS,AND MULES ANORCOULATONS OFTHE BAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIESTHFFOLLOWINO:'ILERTIFYTHA- .V THE PERFORMANCE OF THE MPK FORWHICH -- THIS PERMIT 15 I"UE0,I SHALL NOT EMPLOY ANY PFR.SON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'$MINING OR �- SUS•COHTRACTINO K SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOF FOR WHICH THIS PERMIT IS ISSUED,I*HALL EMPLOY PERSONS SURJFCT TO TION LAWS OF WORKMAN'S COFAPEN ACAUFORNIA.' THE AM/CANT MUST CALL 24 MOURS IN ADVANCE FON ALL R[QULKED INSPECTION$. COMPLETE CRAVING BELOW. SIGNED X _ TITLE: V I \ DATE:L LC..{ / ^•i, r PLOT PAN(DRAW TO SCALE)SCALE_ 'to 1. NAMES OF ST.W.V.O AUS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.ORRUNC OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL f1Y6TEM6. 3, DIMENSIONED OUTUN.e AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WIT141N RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DFIVEWAYS,AND WAIXS. _ THE?OOPRTY OR ADJOINING PROPERTY. I �I T f I I � FOR DIPARIMPRT U6f ONLY APPLICATION At:CEPTEO BY '1•'1 � --- DAT[' I. c ALU A:. TANK,F�1 yR SUMP INSP(CT10N BY�� C' [FAILf�S�•/S [INIAL INBPCf K)N by j!tIGATE ADDITIONAL COMMENTS: — -- ACCOUNTING ONLY: Nb/ _-_--_� FAC/ — �� PE COO[ FEES INFO AMOUNT R[MITT[0 H[CK ASM R[COV6D SY OAT[ N/P016/1T NUKNfJI INVOICE 'L `0 L :2j