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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES r ENVIRONMENTAL HEALTH DIVISION RO• BOX 388, 304 EAST WEBER AVENUE, STOCMN, CA 95201388 12091 4883420 N04 -REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (C.AIPI•t. IE Tr4U.BIAI APPLICATION 18 14EFCW MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT to CONSTRUCT Amumn INSTALL TIM. WOW DESCRIBED, TMB APPLICATION IE MAGE N COMPLIANCE WITH SAN JOAGUIH COUNTY DEVI LONAENT TITLE, CHAPTER 9-1110.3 Ai t) THE STANDARDS OF SM JOACVIN COUNTY PU8UC HEALTH BERWCEB, ENVIRONMENTAL WALTH OMSION, JOS AOORESBIOR .W1/ P/a �% ////� oe (/G,4 CITY LOT KtF oWTfRY NAM[-XT�/�fL}.,NL/N:-ADOPESP , //7 �,c./ �/� PHONE_ y� CONTRACTOR_(* �1JJ1�`/ZL�'V/r1r/�aK % Aomas /�6 .{�c= .�) uC. nanE��3�Q�jjS BUB CONTIUECTOR •ti `iiilLr l" ADTIiSR (11 50 Aw� L! •,!- LIC. —afk Oz TYPE OF StP`M —K: mm MSTALLAnON REPAIRIADDITION U Ourmuc TION ❑ BNO SEPTIC BYBT EM PERMITTED IF PUBLIC SEWER IS AI WTTHN 200 FEET OF 6UIlDINO.I — I -TR) I I HOW -ANY APFS-..S I� INSTALLATION WILL E91V1 PESNDET•K.E ❑ COMMERCIAL W, On1ER ❑ r NUNNUM OF LIVING UMTS: NUMS9I OF B[DIIOOW NlW9t OF 9APLOYEES: CHARACTER OF SOIL i0 A DEPTH OF 3 FEET: L PITISUMP SOIL CHARACTER; WATER TABLE DEPTH SEPTIC TANKPMEASE TMP ❑ TYPE/MFO B4 Z, CAPACHY--/%e-•ri _ No. COMPARTMENTS PIB TREATMENT PLANT ❑ DISTANCE Tp NFARpT: WELL—/O�}Fr FOUNDATION %7 PROPERTY EFT STAMN ❑ SIZE TYPE OF PUMMP SAND OIL SEPARATOR (ENCLOSED SY.TEMI LEACI.NO EINE �q{y(�/ NO. l LENGTH OF LINES_ '� Z (J _ _ DISTANCE TO NEAREBI: WELL FOUNOAiq!/-�/PROPERTY UNE FILTER BED LJ WIDTH LtNOTH_ DEPTH DISTANCE TO NEAREST: WELLFOUNDAYON REOPERTY LINE MOUNDED ❑ WIDTH LENGTH__ DEPTH ofaTANCE TO NEAREST: WELL POUNOATION PROPERTY LIE SEEPAOB PRS ❑ DEPTH SIZE NUMBER OISTA14CE TO NEAREST: WELL F ;DATION PROFETDY UNE StFIM ❑ WIDTH LENGTH_`- DEPTN DISTANCE TO NEAREST: WELL FOUNDATION FROPERry LIME DISPOSAL PONDS ❑ WIDTH L040TH DEPTH DISTANCE TO NEAREST: WELL f-OUNOATION PNSNERrY LIE I HEREBY CERTIFY THAT I HAVE PREPARED THS APPLICATION AND THAT THE WOW WALL BE DONE N ACCORDANCE WITH SAN IOAOUIN COUNTY ORDINANCES AND STATE LAWS, AND MULES AND REOVLATIDMS OF THE BAN JOAOUN CO VNTY. HOMEOWNER OR UCFNKV AGENT'S KOw ATIwIE CERTIFIES THE FOLLOWNO: T CERTIFY THAT N THE PERFORMANCE OP THE WORK POFIWNTSCH THIS PEF"T IB ISSUED, I SHALL NOT EMPLOY ANY PERSON N SUCH A ELHNEA AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALFORNIA.' CONTRACTOR'S HW*M OR N&CONTRACTING MO NATURE CERTINFB THE FOLLOWING: 1 CERTIFY THPT M THE PLIEORMANCE OF THE WORK FOR VWICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS BUBACT Tp WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- TELE APPLICANT MUST CALL 24 RDW N ADVANCS FOR ALL REOIWED INSP[CTIONS, COMPLETE DMWWOO BELOW. 2 STONED X,C��//j TOLE:, PLOT PLAN (DRAW TO SCALE! SCALE _' 1. 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDNO THE PPIOPERTY. A. LOCATION OF /LOUSE SEWAGE 01—RAL SYSTEM OR PROPOSED . OUTLINE OF THE PHOPERTY, WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 2. DIMENSIONED OITTUNES AND LOCATION OF ALL E%tSTINO AND PHOPU,0M STRMTUIES, F. LOCATION OF WELLS WITHIN RADIUS OF DRF HUMORED FIFTY FT. ON RNCLUDINO COVERED AREAS SUCH AB PATIOS, DRIVEWAYS. AND WALKS. THE PPIOPERTY OR ADJOVFM PNOMPTY. .. ......:..... �......:....... .... ...... ;.... ..... ... ... .. ..... . .......:....c.. .. ..... ... .. ........... ...F.... •- . i i N� r�,r� •cic�.�. rPf � : Cti�• d�N��+l� ..:........ .,..,,, MEN ~�0 N wVA i 3 .. .......p...... :...5....:...................^tf'ri L RVICE3 JA'o 1 ..L1 'PUHL K''YL•. C FOR oEFARTM04T USE ONLY APPLICATION ACCEPTED BY \ '(7�7+ "}/E'. �•�� TANK, PPT DR SUMP INBPECTf N BY Q UATE I I FINAL ADDITIONAL COMMENTS: ACCOUNTING QALY: I AIDI TACI AMA: . DATF.JILLLV U —m I FR IWO I AMOUNT ROA17ED I I ALCOVED SY I DATE I BR i r—T M1AIB91 _-_�_ INYDI CEI Pah. Health Serv. - Enviro. 174 (3/98)