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PAVAIENT PEcEiveD 4UG1 2 194i JOAQUIN COI„NrY EiVVInONVIVilft.1-)71 7V,117774VbCk10+1 ...... ........ SAN JOAQUIN COUNTY PURLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER -AVENUE, STOCKTON, CA 95201-388 17091 499 3470 PION.REFUNOAOlE PERMIT EXPIRES I YEAR FROM DATE MOVED lemembot. in If inneatal APPLICATION 10 HERESY MADE TO THE SAN JOACSJISI COUPTTY FOR A RERAN t To CONS I RucT AATLTIR 'INSTALL IHEWOIST DFsCRISED. THIS APPLICATION 11 MADE 04 COMPUANCE WITH SAN JOAQUIN COUNTY DEVELoPMENT TITLE. CHAPTER D-1110.3 AND THE STANDARDS OF GAN JoaouN COUNTY PlJaUC HEALTH SERVICES, ENVIRONMENTAL HEALTH DiVINON. JOB ADDRESSADR AM/ /6 /C3 / tc--;- /2/4/LIT !‹.-/ etiC": CITC 'I LOT EICT.- OWNER'S NAME c,/ c /7/ Ao0RE 5 s 6 ,iT = PISONE CONTRACTOR _f Armnrse PC), 2 ,9!) e51 .-,-: IRONED X Nil Lrivv SUS CONT RAC ToR ADoRFSEI LK , PHOBEL TYPE Of SEPTIC WORK: NEW 1NST ALEADoN El FIEPAIRMODITION pie DEA TiyucrtON 0 MO SEPTIC SWEDEN PERMITTED IF PURLIC SEWER IS AvAILASLE WITHIN 200 FEET or num:mm:1) PERO TESTI.' I 1 How NIANT A0I...10h I INSTALUSTION WILL, SERVE. RESIDESILEVI COIAMERCLAL 0 /MIMI 0 MUMMA OF DVSS° UNITS / PIMASIR OF SEDROOMS NLRIENT OF ENTFLOYEEs CHARACTER OF SOIL TO A DEPTH OF] FEET.,DCA2 4.AII,AP SOT CHARAC TER WATER TABLE DEPTH SEPTIC TANXJGREJUIF IRA, 0 rirr,wci CAPACH, NO. COMPARTMENT 111 PRO TREATMENT' PLANT 0 DISTANCE TO INAKAT WELL FouNnATION PROPERTY ITEM LIFT STATION 0 SIZE TYPE IF PUMP RAND 1-91 SiTIA&M14pF11W Sill SYSTEM, LEACHING UNE 14 NO. II LENOTII Of LIMO / --/e..,--0 7.:- 7-30 05! ONCE frt; NEAREST: WELL ...../ 'Cr-FOONIDAT/ON ...›.(71.-T-1710PEFRY LINE AMR BED 0 WIOTFI LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATON PROPERTY LINE MOUNDED 0 191001 LEHOTH DEPTH DIST ANCE TO NEAREST: WELL. FOUNDATION PROPERTY UNE SEEPAGE ITS 0 DEPTH SIZE NUMBER DISTANCE TO NEAREST-. WELL FOL1MIATION PRE'POTTY LINE SUMPS 0 WIDTH LENGTH DEPTH DISTANCE To NEAREST; WELL FOUNDATION PROPERTY LINE oismiam. ronos 0 TOOTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE HERESY CERTIFY 1 NA I 1 HAW PREPARED THIS APPUCAT/Oft AND THAT THE INOrss wiu. BE DONE IN ACCORDANCE WITH SAN JOAOUTN coLINTY ORDINANCE, AND STATE LAWS, AND RULES AND NEOULATIONS OF THE SAN JOAQUIN COUNTY. HOME OVVITER OR LKENSEn AGENT'S SION AT ORE CERTIFIES THE FOLLOWING. 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FORWHICII THIS PERMIT IS ISSUED, I sHAIJL NOT EMPLOY ANY PERSON IN SUCH 5 sAANNER At TO BECOME RUBJECT SQ P.:0E104MS! COMPENSATION 1AVIII OF CAUTORNIA.' CONTRACTOR'S 44015140 05 SUS-CONTRACTING SIGNATURE CERTIFIES THE FOILOWNO: 1 CERTIFY TF1AT IN THE PERFORMANCE OF THE wOIN, FOR WINCH THIS PERMIT IS IssUED. sHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." THE APPlicANT MLA CALL 24 Nome IN ADVANCE FOR ALL RECLARED INSPECTIONS. COMPLETE DRAWING BELOW. to LE: DATE: • PLOT PLAN ORAW TO SCALE, SCALE I, NAMES OF STREET. DR ROADS NEARENT TO OR BOUNDING THE PROPERTy. 2. OUTIAPE oF THE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTION. 3 DIMENSIONED OUTLINE s AND LOCATION OF ALL EXISTING AND PROPOSED STRuCTUREG:, INCLUDING COHERE!) AREAS SUCH AR PATIO!, DRIVEWAYS, AND WALKS_ E. LOCATION OF HOUSE IIEW AGE DISPosAs SYSTEM OR PROPOSED ExPANSION OF SEWAOE DISPOSAL SYSTEME B. LOCATION OF WELLS WITHIN Rwoulrit or ONE HUNDRED 'Iffy FT. ON TEl PROPERTY OR ADJOINING PROPERTY, OF. TOR DERNITFAENT USE ONLY DATE: LIArt„k OA'a I /171 TART r MAL INSPECTION APPIJCATIoN HOC ER( En BY __(-) CARAAA-"-ALI TANK, FIT OR sUALP :NEIFEcT:014 7)1 IS A rtf flAt Only . /1 /410+ -1-e.mpk sor4G ADDITIONAL COMMENTS. alqc6 See, cAP go-6. AccoUNTs10 ONLY: AIDS PE CODE FEE 11:40 AMOUNT PM i TED ot130:C ASLI ME, OVIED EY DATE INVOICE S BPI I ST nur.:1111P----- A 10 11C I Zo.iz,c) 4;31 g 11 04/ 3,-/ 9.a._-.. D 4 0 8`E'" Pub. Health SON. - EnvIro. 174 (3196)