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. IftliM <br />Wog, ittlyc <br />SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201-388 <br />(209) 46R-3420 <br />NOWREFURDARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER <br />ICemplatz in Trip Reels; <br />APPUCATION IS HEREITY TEAM 10 THE BAN JOAOUIN COUNTY FOR A PERNBT To cONBTRUCT AND/OR INSTAUL THE WORK DESCRIBED THIS APPUCATTON IS MADE NI COMPUANCE WITH SAN <br />JOAQUIN COUNTY DEVELOPMENT ODLE. CHAPTER 9-1 1 10.3 Arep THE STANDARDS of BAN .10AOUIN COUNTY pLISUC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. <br />JOB ADOREBS/OR APNR 626 eg 7 144„vee4"- /eel CITY 7":4 e LOT SIZE _67 4 a <br />OWNERS NAME-ty /2c, k ADORERS 67911,1a- PHONE &? <br />cormucTee C- ADDREss tit er / 1‘.- 5744" me 9W-475— PH°ME 4-3 <br />SUMPS <br />DISPOSAL PONDS <br />SUB CONTRACTOR <br /> ADDRESS LICE PHONE <br />DESTRUCTION 0 TYPE Of SEPTIC WORK: NEW INSTALLATION D REPAKVATTOITHON <br />SEPPC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUII <br />INETALLATIOII WILL. SERVE RESIDENCECOMMERCIAL 0 Y OTHER 0 <br />PERC TESTIs1 I 1110W MANY <br />Appleedon <br />NUMBER OF LIVING LINTS: / MIMEO Of BEDROOMS 3 NUMBER Of EMPLOYEES: <br />CHARACTER OF SOIL TO A DEPTH OF) fEFT. (XV PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH /S <br />SEPTIC TANKIORIUME TRAP 0 TYPE/MEG CAPACITY NO, COMPARTMENTS <br />PCO TREATMENT PLANT El DISTANCE TO NEARPT: WELL FOUNDATION PROPERTY LINE <br />UFT STATION 0 SIZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM <br />LEACHINO UNE .."-IM NO. A LENGTH OF 1INES5,-47 - "cC., ' ....4-4.1(174; DISTANCE 10 NEAREST; WELL lee / _FOUNDATION.. (ID PROPERTY UNE / 5 ' <br />FILTER NED 0 WIDTH LENGTH DEPTH DISTANCE To NEAREST, WELL FOUNDATION PROPERTY LINE <br />MOUNDED ID wieTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br />--Z.... SEEPAGE PITS El DEPTH SIZE NUMBER DISTANCE 10 NEAREST: WEIL FOuNoAnom PROPERTY LINE <br />0 witrrH LENGTH DEPTH DISTANCE 10 NEAREST. WEU. FOUNDATION PROPERTY UNE <br />El WIDTH LENGTH DEPTH DISTANCE To NEAREST. WELL FOUNDATION PROPERTY LINE <br />U <br />I HEREBY CERTIFY THAT I HAVE <br />AND REGULATIONS OF THE AOU OUNTY. HOME 0WhIE UCCNSED AGENT 'B SIONATURE CERTIFIES THE FOLLOWING. I CERTIFY THAT IN THE PERFORMANCE Of THE WOES FOR WHICH <br /> <br />THIS APPLICATION TTIET THE WORC YVILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY °ROMANCES ALSO STATE LAWS. AND RULES <br />141......_ <br />ries PERMIT • soi L NOT Y ANY PERSON IN A MANNER AS TO BECOME SUBJECT TO WOFNMAN'S COMPENSATION TAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR ---1 <br />stre-CONT iHa e AT CE IES 1 FOLIO PIN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 111111SLIED, I /MAU. EMPLOY PERSONS SUBJECT TO <br />WOR(NIAN COMPEH TON C I MUSE CALL 24 HOURS IN ADVANCE FOR ALL REOLIOND INSPECTIONS. COMPLETE DRAWING BELOW. <br />VEINED X TITLE: 4 . DATE: /IO der 7 <br /> <br />PLOT PLAN It3FTAW TO SCALE. SCALE <br />NAMES OF STREETS OR ROADS ST TO OR ROUNDING THE PROPERTY <br />OUTUNE OF THE PROPERTY, WITH EMMEN/DONS AND NORTH DIRECTION. <br />DIMENSIONED OUTLINES ANO LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, <br />ir.ciUme COVERED AREAS BUCK AS PATIOS, DRIVEWAYS, AND WALKS. <br />LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANSION Of SEWAOE DISPOSAL SYSTEMS. <br />E. LOCATION Of WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON <br />THE PROPERTY OR ADJOINING PROPERTY. <br />IS <br />APPLICATION ACCEPTED BY Z dr.h., • <br />TT DEPARTMENT USE ONLY <br /> <br />DATE: <br /> <br />TANK, PIT OR SUMP INSPECPON BY DATE / / FINAL INSPECTION Si DATE 11) / Ci2 <br />ADDITIONAL COMMENTS: 4.71/' L••• et- /lege/WPC./ pe,“1 . 74. it 0/ Sig Ced1_ ?tete -c- 7 <br />Accourrima owc AIDE FACE <br />PE CODE FEE INTO AMOUNT REAM TED CHECK/MASH eocovEo BY DATE <br />- <br />SR/ PIEW•117 NUMBEFT <br />.s-----• ,EsE• <br />INVOICES <br />1)1 i L) ' <br />1 <br />Pdti. Health Serv. - Enviro. 174 (3/06) <br />3401