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SAN JOAOOIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 988, 304 EAST WEBERAVENUE, STOCKTON, CA 95201388 <br />(209) 468.3420 <br />�+ —7 y-,�,.�a� 0 UNDADLE PERMIT EXPIRES 1 YEAR RO ATE ISSUED <br />/ i---- <br />(ConvIst9 In TritJtEAtE) <br />APPLICATION RL HEREBY MADE. TO THE SAN JOAOUN COUNTY FOR A PEnMIT TO CONSTRUCT ANDIOq INSTALL THE WOW DESCRIBED. THIS APPtICATKm 19 MADE IN COMPLIANCE WITH RAN <br />JOAUUIN COUNTY DEVELO PN ENT TITLE, CHAPTER 9-1110.3 AND THE <br />xSTANDADDQ OF SAN JOAQUIN COUNTY P_VBUC IIFALTU SERVICES. ENVIIION�MENTAL HEALTH <br />�pNEaVIM_O <br />N, <br />yJOG AboRE8810R AP"/y 'f/� CITY�s LA.,LO7 <br />2E <br />�"'y2 y' <br />37.rf0WTR'Q NAME ADOnEBSJC�q Kd� <br />////////,OONTIACTOR ���7ADOWFIE; <br />PHONE <br />sun CONTRACFOn ........_• —�i•- <br />TYtn NE <br />TYPE OF OPTIC WORK: N BONITALLATION ❑ REPAIRIADDITION d DOATRUC TIOV <br />.070 SEPTIC SYSTEM PERANFTEO IF PUBLIC DEWER IS AVAILABLE VATHIN 200 FEF7 OF 110ILDNO.1 PSCC .11.11 I H01NMANY <br />f APPb•bn I f <br />INSTALLATION WILL SE[VF; RETICENCE ❑ COMMERCIAL ❑ DINNER ❑ l f <br />NUMSER OF LNINO UNITS: NUMBER OF OFOAOOMS: NUMBEI OF EMKDygM: <br />CHARACTER OF BOR TO A DEPTH OF 3 FEET- P1ISUMP SOIL CHMUCTEA; WATER TABLE DEPTH <br />EP _ <br />STIC TANKAORSASS TRAP ❑ R <br />TYPER.Wo _ CAPACY NO_ COMPARFMENTB <br />FKO TAFATMOIT PLANT ❑ DISTANCE TO NEAREST; WELL FOUNDATION PROPERTY UNE <br />UFT STATION L1 RUE 1YPF OF PUMP BAND OIL SEPARATOR IENCILOSE.D SYGTEMI <br />LEIICHINO TINE ❑ NO. A LENGTH OF UNEB DIeTANCE TO NEA.IIEST; WELLTOUNOATION PHOPERrYUNE <br />ALTER RED ❑ W1DTN LENGTH DEPTH DISTANCE TO NEAREST: WEU. FOUNDATION PROPERTY LINE <br />MOVNDLO ❑ WIDTH LENGTH—OEPTL! DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br />SEEPAGE MTB E-} DEPTH out NUMBER DISTANCETO WAnEST: WELL FOUNDATION PROPERTY LINE <br />SLOW" 11 WIDTH LEMITH DEPTII DISTANCETO NEAREST: WELL_ FOUNDATION HgPEITTY LINE <br />WSPOSAL PONDS ❑ WIDTH LENGTH DEPTH D 9TAWL TO NEAREST: WALL---- FOUNDATION PROPERTY LINET <br />1 HEREBY CERTIFY THAT 1 HAVE PIIF.PAIEO TT9S APPLICATION ANO THAT TI/E 1YOIO( NTLL SF DONE M ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE tAWS, AND RULES <br />AND 01COULATIONB OF THE SAN JDAOUN COUNTY. NOW OWNER OR LICENSED AGENT'S SIUNATURE CERTIFIES THE FOI LOWINO: 'I CEKTIFYT14AT N THEVERPORMANCE OF THE W0W PORNHICN <br />TIBC PERMIT IS IeSUEO, 1 SHALL NOT EMPLOY ANY FERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN -9 COMPENSATION IAM OF CALIFORNIA' CONTRACTORS NIRIHG OR <br />BI10 COMMCTINO SIGNATURE CERTIFIES THE FOLLOWING; •1 CERTIFY THAT IN 111E PERFORMANCE OF THE WORK FOR WHICH THIS PERMrT IS ISSUED, I @HALL EMPLOY PERSONS SUBJECT TO <br />WORK M A710N LAWS OF CAUFORNI THE APMIcANT MUST CALL 24 1101189 IN ADVANCE FOR IIEOUIIFD INMPWCTIONS. COMPLETE DRAWING BELOW. .•�/ <br />SIOTEE , TIRE: DATE: -0 <br />PLOT PLAN 1DIAW TO SCALE$ SCALE, • le <br />1. ? AWS OF STREETS OR ROADO NEARE TO OR BOUNDING THE PAOPERIY. �. LOCAI ION tKA.. IH.., SYSTEM OR PRDIVSED <br />2. OVTUNE OF THE PROPERTY, WITH DN/FNSKNFS AND NORTH DIRECTION, EXPANSION OF SEWAGE UISPOSAL SYSTEMS. <br />3. dMET101oNET1 -MUNE. AND LOCATION OF ALL ";STING AND PHOPOOEO BTRUCTU WO, S_ LOCATION OF WELLS WITHIN RADIUS OF ONE ARMORED FWrl' FT. ON <br />INCLDONG COVERED AREAS SUCH AS PAT" -V. V. a -- <br />i <br />,. <br />a <br />it •.. .,. <br />•I <br />�Q .0 <br />.. .. ....... , .. <br />:.. .... .. ..... :..... <br />.. .A . ..ir1Ti.T.r+>wR+ <br />.....> ..'............... ... p.. .t...- <br />.. .................' 11.1!,x.: <br />........... t 1 <br />....e. ...: i <br />j <br />... <br />.... .. ..... ...l .. <br />:. <br />I•V <br />....... .:... ..:......y.. ..l... .. <br />..... �.. ..F,.......;...... <br />Y <br />... .. :. .. ;......,.....-r.. ; <br />; <br />i <br />.. .. ... 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F�l'1811 <br />CREA <br />._. . <br />...... <br />.:°..... ... <br />.........a......: .. ..;Y <br />FNlIiiONA6NTA .01131oi•...., <br />AMLICATKIN ACc, P",O DY` <br />TAMC, PH OR BUMP INOPECTIOIE OY <br />ADINTIONAL COMMENTS; A <br />ACCOVNTING ONLY: I AID; <br />PE CODE I FEE INFO I AMOUNT ROVD-FTS, <br />Pub. Health Sorv. • EnWro. 174 (3/96) <br />FOR DEPARTMENT USE ONLY <br />PATE: <br />_ OA7E 1 1 FINAL INSPECTION BY� <br />FACT <br />RECUVED NY I DATE _ SRI PERMIT NUN79ER I 1HvpCE P <br />