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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES F ENVIRONMENTAL HEALTH DIVISION 1 P.O.BOX 388,304 EAST WE13ER AVENUE,STOCKTO R CA 95201388 (209)469-3420 NOR-RELURDARLE PERMIT IXPIRES I PEAR FRDMD1)TE 1$201D IC/WglPr in T14RAWE$I A►FUCATTON h HFFW MAD!TO TTE SAN JOAOUIN COUNTY"A POW IT TO COWrFfJCT ANDAM*"TALL Tl!WOM OESCPWWM. TTM APPKLCA170M M A&AW M COAF%A%K=HPPI SAN .OAGM CCway DEV6AIA as TYRE CPNITTII¢7110,3 AND THE TRAIOMOS OF WAN JOAOIIN COUNTY PUKx HM714 WNVICES.FWWWOP/AOTTAL HEALTH DmftDN- 'AIEADDIEI$rOR APE/ S9�a u,F,-,�/fit/a!3 n�-J�.L �"Y_�GnMT-- LOT IVA 1JLNIOF'E NAME- �YA2� rnr117 /nI y' /neA`ADDM" Sar,.. BONE_ oON—To+t(=21yaL 14,� r ADOAEnJor,N lt-,�,++�..rw 1�-IS'c' uct y596-15`moon NE027 OUR COPVWAC'TOR ADOIE/S LA:/ T1PON( Tvm OF xWm V-W: MW WSTALLATION Q IIMAWAODRION❑ OuTMICT70N❑ TPAD NEPM EYSTEW PFF*AMTIEb■PUNJC SLNWER IS AVAAAWU WITTMN 900 FEET OF SUSDUIO.1 P PD TaTNI l I IIOTF MARY ' APPSAAIbn/ NSTALLJLTION MILL sum: IE$OFHCE 13cOMMENdAI lk OTHER 13 FRhAD/t OF UVEW LWIS: HARMER OF OKSOOMO: NLMM OF OWLOYM: CHARACTLNI OP SOIL 70 A DEPOT OFF3FEFT:. 5j2nkJ PfTAULIP$OIL CHARACTEW_d, IL.l WATER TAW DEPT! SWIM TANE/OKAM TPpAAP�I RTVPER�FO S—sejt cAPAcm a• 1 WG NO,cowARTLwkTJ PHO T"CE TMBTT PLANT Ty DIOTANCI TO LRAAOET: WRL FOUNOATION PMF[ATY LINE. V1T/TATIOII 51 WE SW Ar+L.TYPE OF KWP•,6M.L1_$AM MI OS EEPAPATOR(OKLOEED fY$TE1 LAAOIWFIO LAY I&ND.A LEWTH OF UNEP'_-4VY1 1 Z>+kjl"C UIBTNKE TO NEAM WT:WELL FOUMIAT0)11 PIOPERTY 1YE IMTMI%m C3 WOTTH LFADRI- DEPTH DiSTAJ10E TO NEAMET:WELL FOUNDATION PF0VRWTY UNE WO11pO ❑VAOTH LFNOTT/ OrPM p1/TANCE To NFMf7:WELL FOUPDATON FFOINPRY LJW SEAQ RTE Isom" 'a, ERE—ji Alm_MNAEER_6_OYTAFKE TO NEAMST:WRL MWOATMN POPUDY L/E SMIlS ❑WDTH LfNOTH_=COMM DISTANCE TO HEAFE(T:VAEIJ FOVID/LTONE N FFWFMY Lt 1� BRPO4AL PONOS ClVMTH LENGTH DEPTH OM AMC TO NEAMM VJM, FOUNDATION PPOPOfTYLWE Kr 1 PEACHY CIRMY THAT 1 HAVE PM30AMM TTIE APPUC1T10N AND THAT TME WOPK WILL OE Do1LE M ACCOMANCE VWTH SNI 40AUUY1 COUNTY OIONAMES AND WFATE MWR APO TERES AND REOULATIONO OF THE SNI JOAOLAII COUNTY.HOME OWNER OR L1C7NOEb AOMT'S EIONATUIE CENRFES TM FOLLOWM'T CMWY THAt N THKKNOIFI/WCE OF TIE WOIK FOR WISCH TTS FOPIET Y ISFUFD.1$HALL NOT FLVWY ANY PIIIPON N OUCH A MAMEA AS TO OECOME KWACT TO WORLMAH•E COAIFOI$ATON LAY@ OF CAUPDMA. A ' OONTNACTOFI.O WPM OR NC WAH)OWPACTO WGNATUF!CEFTM"THE FOtLOWIAI:1 I CERTTHAT N TIFF PgiORMANCE OF THE WOM FOR WN,CN TMO WJWET IS IOSUEU.I SFULL UNWY F'8001 E MJ6CT TO l/J. ~03AAII'S COVENMTWN LLWO OF CALIOIMA.• THE APPUOMT MWT CALL 24 HOURS 111 ADVANCE FOR ALL IIIO•JEED DFOP�'TIOES. COW"'-IVWAIA BROW O i �� ! o WIrED x TRLE:T/Ai.K�'yc GATE:)�� PLOT FLAN MAKW TO SCALP/CALF _•a 1.NAMES OF STILETS OR FIOADS NEAFEET TO OR WOUNDING THE PILOPEILTY. t.LOCATION OF MNJSE$EWAOE DMUSAL EYSTTAI ON PPOPOEED { 2.DUMNE OF THE PMPENTY,VMT4 DIMENSIONS AND PIOWH OWE— EXPANSION OF SEWAGE OIOPOSAL CMTftW. O. DILENOONFO OVTUIIES ANO LOCAMIN OF ALL EMWTSU AND PROFORO WTRIICTUMV, E LOCAtON Of LM"VIM4W FAD"OF ONE WNDO m FIFTY PT.ON BICL1MM COVHOED AFWAS SUCH M PATOO.D WWWAYS.AMD WALKS. TW P7OPERTY OR ADJO04M FFIOKNfY o T... , .... ...... ...;......`...._. . j.....d.... I i.......... .... . .i....' R i... .... ....: ... ... ... .. <.... . EgLrt `FA4IUl.,�. { cN SU MSN - fr... .....4....... ....: � TAS HEAL7M UII�IS ... :.....:..... '......y' .i.., i .........: FON DWAWMWT USI OIAY ,IP,UDATION ACCEPTED BY V{/ f PATE: y- I�T ,7 A1IFA � I T#V JU OR SLA!NSPtCTION SY71 GATE /LL T RNWSfLCTON DDADDRIDDMALCOMMEMS: —T ACCOUKTIIPO OW'T: AOf !KA PE COO[ FEE two AMOLNT PW WITW C/IECE/ 14C SFV®BY DATE OR 1 PBOIOT PIUM I 111V010E i b y L" PI'.D.P OMM SON.-E—ko.174(3M) rte.