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71•10tit'114 <br />OLLS <br />11-:toy• • • •• <br />-PPIME NT <br />PECE!YED <br />oci• m 9.1997 <br />" <br />APPLICATION FOR 111111ID WASTE PERMIT <br />SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388,304 EAST WESER AVENUE, STOOMN, OA 95201-388 • <br />(209) 481.3420 <br />• <br />NO)1,11E.f1BIORM PERMIT WIPES 1 YEARFROM DATE ISSUED <br />(Gigolo& hi Triplleatsl <br />Arruc&TroN 18 HF.FIEBY MADE To THE sAN JOAQUIN cOLINTy FOP. A PERMIT TO CONSTRUCT AND,OR INSTALL, THE WORK DESCIRBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br />JOAOUIN COUNTY DEvaopmEhrT TITLE. CHAPTER 9-11 /0 3 ANO THE STANDARDS OF S N JOAOUIN COUNTY PUBLIC HEALTH RERV7CES, ENVIRONMENTAL HEALTH DIvnI;014, <br />XIS ADORESS/OR APNV ° F3 7 //,4 s e.44 CRY //14,47/ LOT SIZE 5-"ArIte <br />OWNER'S NAME a 4,44. ;Rd g/. 'CA. ADDRESS 'G •04 ,44"--- PHONE Sc- 6 777 <br />cONTRAcTon /e,14;1 4.1 '5 .eAPX Aceme/Zi r uc, ,i9e/1-25-m.aNtt/e03-1-3 <br />OUR CONTRACTOR ADDRESS UCI PHONE <br />TYPE OF SIITTIC WORK NEW INSTALLATION 0 REPAIR/ADDITIO <br />4140 SEPTIC SYSTEM PERMITTET) IF PUBLIC SEWER II AVAILABLE WITHIN 200 FEET OF OUILDiNCI.) <br />NIS TALLAHoN will NERVE: RESIDENCE ICOMMERCIAL 0 OTHER 0 <br />umBlipt or MING MOM 4( NUMBER Of ItEDOICIOMS: <br /> WATER TABLE DEPTH. / c.c;s3 <br />DESTRUCTION <br />PlC TISTto I 1140W MANY <br />ArESo•Oor, <br />NUMMI Of LIMPI.OYEIPS: <br />CHARACTER OF SOIL TO A DEPTH or 3 FEETC/FR V. <br />LENGTH DEPTH <br />.5,41,nee FTT/SUMP SOIL CHARACTER7 <br />SEPTIC TANK/GREASE /RAP 0 TYPE/Mr(1/ CAPACITY NO. COMPARTMENTS <br />TKO TREATIELTET PLANT 0 OfsTANCE TO NEAREST: WEU_ FOUNDATION PPOvERTY UNE <br />Ur'T STATION 0 SIZE TYPE of PL/MP BAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEAcHwo uNE 74- NO. A LEMITH OF UNES 02 - SO '..i--rt •r":. /V. DISToVICE TO HEARENT: ww./041 ' _ FOUNDATION 2,t- PFIOPERTY UNE S- <br />I I <br />RLTER BED <br />GE I <br />DISPOSAL PONDS 0 MOTH <br />0 MOTH <br />0 MOTH <br /> LENGTH <br />LENGTH <br /> SUE NUMBER <br />DEPTH <br />DEPTH DISTANCE TO NEAFIERT: WELL FOUNDATION <br />DISTANCE TO WARM: WELL FOUNOATION PROPERTY UNE <br /> DISTANCE TO NEAREST: wat FOUNDATION PROPERTY UNE <br />INSTANCE TO NEAREST: WELL <br />: <br />FOUNDATION <br />PROPERTY UNE <br />I <br />sEEPA NTO 0 DDEPTH <br />mouton <br />PROPERTY UNE <br />UMPS 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST WELL FOUNDATION PROPERTY UNE <br />I HEREBY CERTIFY THAT I HAW PREPARED TN. ATION AM) THAT THE WORK WILL zE DONE IN ACCORDANCE WITH SAN JOACNAN couNTy °FINN/VICES AND STATE LAWS, AND NILES <br />AND REGULATIONS OF THE SAN JOAQUIN C ME OWNER OR MOTU AGENT'S SIGNATURE CERTIFIES THE riM.LOWING, ',CERTIFY THAT IN THE PERFORMANCE OF THE WONG FOR WIIPO H <br />THIS PERMIT IS I*MES4 RH EM OY ANY SON IN SUCH ANNER MI TO BECOME SUBJECT TO WOFEDUAN'S compENSArioN LAWS OF CAUFOINEA, CONTRACTOR'S HIFENG on <br />Sue-CONTAAcT sin AT c THE fOLLO '1 c THAT IN nfE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO woowki&ors PENS I LA Or AUFORNIA, THE APM.IC MUST CAL:. 24 HOURS IN ADVANCE PAR ALL REGURED PMPICTIONS. COMPLETE DRAWING BELOW. <br />Tr LE: cold. io -?-9 <br />PLOT PLAN LORAvi To SCALE) SCALE <br />NAMES OF STREETS on IRDAOS NEAFIEST To OR SoUNINNO THE FROMM/. <br />OUTLINE Of THE PROPERTY. WITH DRAENSK/N8 AND NORTH DIPECTION, <br />J. DIMENSIONED OUTLINES AND LOCATION OF AU. EXISTING AND PROPOSED STRUCTURES, <br />INcLvoN40 covinED AREAS SUCH AS PATIOS, DRIVEWAYS. AND WALKS. <br />"0111/4 5I'LL <br />Cavt-01 <br />- I. <br />A. LOCATION Or HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANINOIY OF SEWAGE DISPOSAL SYSTEMS. <br />S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON <br />THE PROPERTY OR MXIONIIN0 PROPERTY, <br />; <br />•"ilkist JOAOutO <br />;.tii3LIC sviWicES <br />-,t-•,issioesriat HEi\LITH DIYISluN <br />FOR DEP APITM1301 USE ONLY <br />A. <br /> GATE / / :1‘1.1'art141 FINAL INSPECTION NY <br />AREA: <br />DATE /0 ji_r_22 <br />APPLICATION ACCEPTED BY <br />TANK, PIT OR SUMP INSPECTION BY <br />DATE: <br />ADDITION AL C OMMENT <br />ACCOUNTING ONLY. AIDE FACE <br />oda.. <br />1._ PE CODE FEE INFO AMOUNT /MATTED 4711 IC MN RECRVED BY DATE SRI revAn NUMBER INVOICE 1 <br />1 I . <br />• <br />4 lei <br />IAA aila i 11 0' f <br />••• di ., O tt/q 44 7 <br />-