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33 IVLILA 111NNK LIUUIUWASI t�Ytl{i I I SAN JOAQUIN COUNTY PUELIC HEALTH SERVICES ENVIRO;:'.;ENTAL HEALTH DIVISION P.O.BOX 328, 446 N. SAN JOAOUIN ST, STOCKTON,CF, -Ai-0388 (209)4683420 NON REfUNOABEF PEAMIi EXPIRES 1 YEAR FROIA DATE ISSUED (Complete w Triplicate) APPUCATI"JN 18 HEREBY MADE TO THE SAN JOAOUW COUNTY FOR A PERNIJ TO CONS]AUCT ANU.OR INSTALL THE WORK OESCRIBEO. THIS APPLICATION 13 M%D[W COMPLUNCE WITH SAN JOAOLUN COUNTY DEVELOPMENT TITLE,CHAPTER 9--11'11/1)��I.3 AND THE STAWMALS OF AN OADVIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION, JOB ADDFIESS.OR API t �( /LJ/ � ` /V. 4-<<-7F'1��/I J� ` .1 %CITY )C�•�1 !,-1 .�. LOOT SIZE M OWNER'S NAE/ �l_/��{ I/ /1 """''� ADplfcc(�C�.[�(7L'1 /�O s ///'(-�,4y,•T -1- /�"( _iMONE1or p -37co 7 CONiMCTC/ iE-��Q %�1I. —1ADDRESS 1.�• r)�Y7(.-� �/`IC1 _UC/ SIM CONTRACTOR ADOREFS LIC/ PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ROAWADOITION ❑ DEATnIICTON❑ SFO SEPTIC SYSTEM PERMITTED F PUBLIC SEWER IS AVMLABLE WITHIN 200 FLET Or BUILDING I ►f34:T-11,1 I 1 HOW AAANY Apps-/ INSTALLATION WILL SONE. REG+DENCEV COMMERCIAL❑ OTHER❑ NIMOI OF LIVING UIRS:—L NIAMSM u SEDRDO -'�? NlIM1191,OF E MPLOY6S. _ I CHARACTER OF 903LTO A DEPTH OF 3 FEET: PITISUMP SUK CHARACTER: WAT:R TA.41E DEPTH I,20 SEPTIC TANKANWASE TRAP �TWUTAFO CAPACITY(,A n0 kO.COVPARTMENTS_3_ T / PKG TNEATMEPIT PLANT❑ DISTANCE TO NEAREST: LL S 1 FOUNDATION .Z's� PROPLRTY UNE VT STATION❑ BRE TYPE OF PLVAP� SAND OIL SEPARATOR IE'1C•-OSP D;Y STEW LIACNNG UNE XNO.S LENGTH OF U.I. 41O r DISTANCE TO P1.EAHEET:WELL /e)0-Y,FOUNDATION /Q"f PROPERTY UNEP__ ASTM SSD ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:NFLL FOUNDATION PROPFRTY LINE L MOUNDED ❑N1DTM LENGTH DEPTH DISTANCE 1'0 NEAREST:WELL_FOUNDATION PROPERTY 11NE_� \�•// SEEPAGS FITS �.D[PTH rY S SIZE —36 NUMBER__-3 _INSTANCE TO NEAREGT.WELLLQ�'FOUNDATION PROP-)rY UW auk" ❑W1OTN LENGTH DEPTH (AStANCE TU NEAAEBT-WELL FOUNDATION PROPERTY UNE OWPQGAL PONOS ❑WI7TN LENGTH DEPTH DISTANCE TO NEAREST.WELL FOUND.TION/ PROPERTY LAK I NEFO W CERTIFY THAT I HAVE PREPARED TP"APPLICATION AND THAT THE WORK WILL BE DOW W A.^-CORDANCE WITH SAN JOAOUIN COUNTY ORDWAFF_E3 AND STATE LAWS.NFO RULES OU AND RFAULATIONS OF I HE SAN JOAN CLIJNTY.HCMF OWNER OR LYtNE{FI^GEM oSk' WATUE CERTIFIES THE FOLLOWING:'I CERTWYTHAT W THE PLRFOPAUNCE OF THE WOW FORWlSCH THIS FU"T IO ISSUED.1 SHALL NOT UWWY ANY PERSON N SUCH A MANNER AS TO BECOME F'15JECT TO WOHLMAN'S COMPEJUSATION LAWS OF CAl1FOFNIA.' CONTAACTOR-f WAND OR WIBSONTPACTM IMPLATIME CERTIFIES THE FOLLOWNO:'1 CERTIFY THAT IN THE PERFOAMANCE OF THE HONK FON WHICH THIti PERMIT IS ISSUED,1 61ALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATRGN LAWS/OF CCAUFORMA.' TIE APPLICANT MUST CALL K WLRS W ADVANCE"ALL M.LoREEG INSPECTIONS. COMPLETE DAAWNO W.OW. - SIONfOK \ (y(`•'S/Y/',-/"'"' _TITLE 1. DATE: f PLOT PLAN CMAW TO SCALE)SCA:.E '10 1.NAMES OF STREETS OR ROADS NEAPEST TO OR BOUNDING THE PFIJPERTY. E. LJCATION OF HOUSE SEWAGE DISPOSE SYSTEM OR PROPOSED 2.OUTLINE OF THE PFWPERTY,WITH DIMENSIONS AND NORTH DWECTION. EAPA.%b43N OF SEWAGE DISPOSAL SYSTEMS. F\ V 3.OWEEJ610F1W OUTLINES AND LOCATION OF ALL UUSTWO AND PKWO.SED STRUCTURED. G. LOCATION OF WARS WITHIN RADKM OF OW HUNDRED FIFTY FT,O I INCL11004 COVERED MEAS$UCH M PATHS.OMVFWAYS-AND WALKS. THE PLOPRTY OR ADJOINING PROPERTY. rvq Z/O F L r f ��J 11 L It N1- ` ' a JG 1 1995 FOA DEPARTMENT UAE ONLY 1✓`•�',' O�T r I APIEJCATON ACO111 i0 YY / _ I. �� UAIE FI1M[/Il URISNM/I 01110-11 CAIN SY OA CI WAL IhSPL Ci10N BY / .-C. G,y�Gb LI DATE I �I ADORTIDNM COS/eetMlP: / ..- ACCOLINTINO ONLY. APW .—_-• - IA[/ _ -- K COD) P[E WIFE AMOUNT REANTTLD CMCKN,*"/ RECLINED SY O/ATE / &A,POW Y NUMSM INVOICE IF �V