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SAN JOAOUIN COUNTY P991IC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 55201.988 17091469-3429 NONFNEFUNDABLE PERMIT EXPIRES I TEAR FROM DATE ISSUED .�x^� _ ` n o,J rOBmPI `J/T/16 Tripkatel v `.- l APPLICATION ID HEREBY MADE TO THE BAN JOA0IAN COUNTY FOR A PERMIT 10 CONSTNIXT ANOIGA INSTALL INC WOR(OESCMWO.THIS APPLICATAN I/MADE N Cd/TRANCE WWA SAN JOAQUN COUNTY DEVAOPIMETT TITLE.CHAPTER 9-1110.3 AND THE XT NDARRD9 OF SAN JOAMN COUNTY PUBLIC HEALTH BERCES.rwmFSNmENTµmmT/ DIVISION. JOD AOOR89JOR JWNE OT BELN J 14Q r L , C� OWNER'/NAME /' � ORESB R10f/E�/�/i ` COIIfT1ACT0/1 �n 00.1 �� AIIDRESB �/ r IN 1 LIG. 16YE R10NE�/K' / SURCONTRACTOR ADORES. DRC► PHONE TYPE or sorm wow! NEw N/rA1J.AT10N IFEPNRlAOdTMN❑ OODR/CTION❑ INO SEPTIC SYSTEM PERMITTED IF FUSRC SEWER IB AVAILABLE WITHIN 200 FEFT OF RUB OINR.1 ,9N,TEITNI I I NOW MANY AFFBeMAn/ N/TALLATION VALL 89111!: PESIDLN-E IX COMMERCIAL❑ OTHER[I _ NUNLS6l OF IJVN0 INIT8:_II NLNSSI OF BEDROOMS:_ NIM191 OF EMPLOYEES _ CHARACTER OF got TO A DEPTH OF J TEET: J PITISUMP SOIL NARACTER: WATER TABLE DEPTH - tET71CTANIIGIEASITRAP ❑TYPFZ;lT T M APACOY 2QL7C-> NO.COMPARTMENTS Z - -- PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE LINT STATION❑ SIZE TYPE OF PUMP RANO 011 SEPARATOR IFNCI.OSEO SYSTEM) r / LIACNNO UNE 13NO.A LENGTH OF LINES �3- (j I DISTANCE TO NRAALBR:WELL-/5-Z-> /FOIINOATION /°-PROPERTY IM4�y,�� FILTER BID ❑vmr" LENGTH DEPTH DISTANCE TO NEAREST:WFIl To11NDATION PROPERTY IMS MOURbM ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL POUNOATION PROPERTY UNE_ IFE►AOE NTD ❑Fy DEPTH a-5/ SITE_-;j j7 ryUMBFR�' _DISTANCE TO NEA E.T!WELL I. I FOWAIATON f_ PROPERTY LINE �S /UMW LJ win t" LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE DISPOSAL PONOS Cl WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WFLLFOUNDATION PRIORI LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED TISD APPLCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN:OAGUIN COUNTY ORDINANCES AND STATE LAWS.ATO AIRIER AND REGULATIONS OF THE BAN JOAGIIN COUNTY.HOME OWNER OR LICENBED AOENTN SIGNATURE CERTIFIES THE FOUGWNO:'I CERTIFY 7 HAT LATHE PERFORMANCE OF THE WOW PORWHICH TRIO PERMT 18 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN BIRCH A MANNER AS TO BECOME SUBJECT TO WORfMAYB COMPENSATION LAWS OF CAUFOESNIL' CONTRACTONTS RARING OR BUS•CONTNACTNO SIGNATURE CERTIFIES THE FOLLOWING:-I CERTIFY THAT IN THE PTRORMANCE Of THE WOFK FOR WHICH THIS PEWEE IB ISSUED,1 SHALL EMPLOY PERSON/BU&fECT TO WORKMAN'S COMPENSATION LAW48 OF CAUFORRA' THE APPLICANT MUS'!CALL 24 HOWRS IN ADVANCE FOR ALL AFDJRW INSI ECTIONS. COMPLETE DRAWING BELOW. BONED X jLa.cP � .0 J �'i� TITLE:C�L..'A7 ��Q j O�_ DATE: ROT PLAN DRAW TO SCALEi SCALE__-t 1.NAMES OF STREETS OR LOADS NEAREST TO OR BOUNCING THE PROPERTY- 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED E 2.OUTLNOF THE PROPERWITH TH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, O.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTINO AND PROPOSED,.T UCtURE- 6.LOCATION OF WELLS WITHIN RAMS OF ONE HUNDRED FIFTY FT,ON PKLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALA8. THE PROPERTY OR AD/ONNO PROWITY. ........:.. _ :.. i.. .t e.... .,.... . . ,CcJArBr ': . . ...:.... ..<. .; . - .. ........ . o - - - - r _ _ V. r i...i.............._c - m u�B .........:.. ..... -ri i .. _ _......Fit ..........i :. ¢.... j.. _ .. 4. : 0 v1 .. .......e............. . f a r FOR DIWARTMENT USE ONLY APPLICATION ACCEPTED DY DATE / D , AREA OR SUMP INSPEC TAN OV D / FINAL RASPE=ON ADDITIONAL COMMENTS: ACCOUryTNO D:AY: AKAR FA[t 6'(" OV'��✓�.! PL COO! FEE INTO I AMOUNT RUIWIlTED CIC I H MCWED DY DATE NR I PERMIT NUM8B1 INVO / P.D.HeRfth SGAv_-ETVIfo.174(3(96)