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APPLICATION FOR LIOUIO WASTE PERMIT SAN'JOACUIN COUNTY PUBLIC HEALTH SERVICES r ENVIRONMENTAL HEALTH EIVISION P.O.BOX M 304 EAST VYEBM AVENUE,STMKTON,CA 95201388 1 12091498-3420 NOR-REFUNDABLE RMI EXPIRES YEAR O DATE ISSUED ICPmpl.lt IR TrlpRatlt) APPLICATION IR MEnERY MADE TO THE SAH JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOJOR INET LL THE WORK DESCRIBED.YAPS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 81110.3 AND THE PTANDAADS OF BAN JOAOUIN COU PUBLIC HEALTH SERVICER,ENVIRONMENTAL HEALTH nIVRON. Jon ADORumn APNf 049-07-15 1500 E. Vine St. CITY Lodi LOT SIZE 40ac OWNER'S NAME Tones_.rnture - AbbAfS. 0LodiAse.- Lodi CA 95242 PHONE369-7335 1826 a e CONTRACTOR Dale R. Jolley Co., ADDRESs LIC# 442555 PHONE334-1395 SUB CONTRACTOR AbbREeB LIC/ RbNE I .TYPE OF SEPnC WORK: MEW INSTALLATION❑ REPARNAOOITION❑ DESTMUCINOM IND SEPTIC RYOTFM PFRMD'TED IF PUBLIC SEWER IR AVAILABLE WITHIN 200 FEET OF BUILDIHG.I E91C tEYT1T1 I I HOW MANY APPto.F.A F INSTALLATION WILL OEM: RESIDENCE❑ COMMERCIAL❑ OTHER(3 NUMOM OC tmNO UMTS: 1111M1091 OF BEDROOMS: NUMSHI OF.EMPLOYEES! CIIARACTEII OF SOIL TO A t)EPHI OF I PEEP: PITISUMP BOR.CHARACTER? WATER TABLE DEPTH SEPTIC TANKMEASE TRAP ❑TYPE/MP6 CAPACITY NO.COMPARTMENTS PBD TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL_ rOUNDATIOV PROPERTY UNE UFT STATION❑ SRE TYPE OF PUMP SAHb OIL SFPARATen Mm L0 SYSTEM) LFACIaNO UNE ❑ NO.A LENGTH OF LINES INSTANCE TO NFARE nz WELL FOUNDATION PRDMI rY UNE FILTER RED ❑WIDTII LENOTH DEPTH DISTANCE TO NEARS ST:WELL FOUNDATION PrOPERTY URE MOUNDED ❑WROTH LENOTH DEPTH DISTANCE TO KAN ST:WELL FOUNDATION PROPERTY LINE SEEPAOE PIT& 11 DEPTH SI2E NUMBER DISTANCE TO PRE ST:WELL FOUNDATION PROPERTY UNE SLBAPt ❑WIDTH LENGTH DEPTH DISTANCE TO HEA ST:WELL FOUNDATION ROPEW V LINE DISPOSAL PONDS ❑WIOTM LENOTH DEPTH DISTANCE TO NEA ST:WLT-L FOUNDATION PROPERTY LINE 1 HEREBY CEATIFY THAT I IIAVF PAFPARDO THIS MEDICATION AND THAT THE WORK WRL BE TONE IN ACCO ANCE WITH SAN JOAGURR COUNTY ORDINANCES AND STATE LAWS,AND RDEN AND REOULATONS OF TILE SAN JOAOVIN COUNTY.HOME OWNER ORUCENRED AaENT'R BIONATURE CERTIFIE THE FOIZOWINO:'I CEMIrYTHAT IN THE PERFORMANCE OF THEWORK TOnWHIC1I THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRNO OR SUS-COMRACTI SIGNATURE CERTIFIES THE FatLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE FEW C FOR INCH S'THIS PERMIS ISSUED,I SMALL EMPLOY PERSONS SUBJECT To WORKMAN'S C NRA ION LAWS OF CALIFORNIA.* INV APPLICANT MUST CAU 24 VOL"IN ADVANCE MR ALL RECURRED INEPECTIONt. COMPLETE DRAWING BELOW. SIaNEbx TITLE�.�.t-Lj'eLJ'Q DATE: 33;_26 PLOT PUO)(bRAW TO SCALE)SCALE •e. 1.NAMES OF STREETS OR 1OAD8 NEAREST TO OR BOUNDIND THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE D81*08AL RYNTEM OR PROPOSED Z.OUTLINE OF THE rODTEMY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DSPORAL SYSTEMS, 1. DIMENSIONED OUT UNES AND LOCArtON OF ALL EKISHNO AND PM PaStO STRUCTURE.. E.LOCAT W M OR WILL.--RAe,V.o•e.rE�n/NONFp FDTV tP.oN INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPER,Y OR ADJOINING PROPERTY. .- 5,. ... ) ; S „ 1 { . 1 FOR DEPARTMENT USEONEY �`. y f+n JA C AFPLMATION ACCF.I!EO BY DATE: O1}UI f b J Q __AREA:FWA P%-6" 71 TANK.IIT OR BUM)'INSPECTION BY, DATE-7 11'71 1�-fI AL INSPECYII a t �A�"D -� T-DATE AbDITOONAL ACCOUNTING ONLY: AIDE FACS BE CODE FEE INFO AMOUNT REMITTED I ASH PFCFIVM NY VA"t to I PERMIT NUMBER INVOICE f yea 7,760- roe s �a� a taz4g