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<br /> HEALTH SERVICE!. /3 9S_ ,,,, �-4• ••�W
<br /> � t y111 ENVIRO, TAL HEALTH DIVISION �1 , _ ��FR e is
<br /> ,��,•-yy ���' 8,446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201.0388
<br /> ROW 488"3420
<br /> NON-REFUNDABLE PERMIT EXPIRES 1 Y(R FROM DAYEISSUEO) Iii .-4r `"<< ✓4 s d r��
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<br /> APPLICATION 18 HZtRY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WWW DE'BCRIDED.THI8 APPUCATION 18 MADE IN COMPLIANCE WITH SAN
<br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9.1110.3 AND THE HOARDS OF SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION.
<br /> JOB ADDRESS/OR APNI (Da I /-. Cfr4S��4— a l LOT II-EkLD 7,
<br /> WJNER'S NAME S U V S e..l ADDRESS PHONE �_� �7
<br /> CONTRACTOR ADDRESS(7O`�.�.Ctd elber4-- UCB PHONE.gUJt'-J7tY
<br /> SUBCONTRACTOR ADDRESS ������ppppppTTTT LICS PHONE
<br /> TYPE OF SEJTC WORK: NEW INSTALLATION 13REPAIR/ADDITION> _ OEfTRUCTION❑
<br /> IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) FM TESTI.1 t I HOW MANY
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<br /> INSTALLATION WILL SERVE: IDENCE❑ COMMERCIAL❑ OTHER RJ -
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<br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:Q NUMBER OF EMPLOYEES: ^{r`c
<br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PTT/SUMP SOIL CHARACTER: WATER TABLE DEPTH �1 T� ��jj ((�T
<br /> SEPTIC TANK/OREASE TRAP ❑TYPE/MFO CAPACITY NO.COMP 8,]
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<br /> PKO TREATMENT PUNT❑ DISTANCE TO NEAREST: WELL / FOUNDATION PROFt"L#@A4 IUAI
<br /> UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM)�(��(P�{�I'E,ir`LI II(CI�E.AL M SF I?V!C F,..j
<br /> LEACHING LINE ❑ NO.L LENGTH OF LINES DISTANCE TO NEAREST:WELL IFVUIIDATIo� TAL HbA6k*&lwkfoPl
<br /> FILTER BED ❑WIDTH LENGTH DEPrH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE
<br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL ,,-/� FOUNDATION��'�yMM�"""��'��'PRDPERrY UNE
<br /> SEEPAGE RTS ❑DEPTH SIZE NUMBER_DISTANCE TO NEAREST:WELL1 7L/f�'f FOUNDATION PROPERTY UNE
<br /> BUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE '
<br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE
<br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THI8 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RVLE8
<br /> AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'(CERTIFYTHAT INTHE PERFORMANCE OF THEWORK rORWNICH Q
<br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORNIA.- CONTRACTOR'S HIRING OR O.
<br /> SUB.CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO (�
<br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW.
<br /> SIGNED% C A TITLE:J/1 ViL DATE:
<br /> PLOT PUN IDM O BCALEI SCALE "to
<br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED ;
<br /> 2.OUTLINE OF THE PROPERTY,WITH DIMEN81ONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS.
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<br /> APPLICATION ACCEPTED BY 1� DATE: l AREA: L I
<br /> TANK,PIT OR SUMP INSPECTION BY D(� l r DATE / / FINAL INSPECTION B I��- '/ DATE 2/ PE—
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<br /> ADDITIONAL COMMENTS: �.[I w.hQ.. v6j.AM P1_i C- r v /i' _
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