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—4/31— TITLE _ DATE. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS S. LOCATION Of WELLS WITHIN RADIUS OF ONE HuNDRID Fifry IT. ON THE PROPERTY OR ADJOINING PROPERTY. tO wean' '17X5 ..... ...... . ... ; . ;• .. . ...... . ...... . „ "PAYMENT . RECEIVED:. , JUL - 8 1997 aiX'X ; Ult•Lla . etiquC HEALTH SERVICES ENVIiriONMENTAI HEALTH ntieistor,r - &REA DA,7 / 11 7 SAN JOACWIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 85201-388 (2091 48R 3420 NON-REFIINDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED iCoteptete in Triplicate' AMIGA-1101119 HERESY MADE TO THE BAN JOAQUIN COUNTY FORA PERMIT 70 CONSTRUCT 4110/004 INSTAIL THE WORE oEscilifiED. THIS AWE/CATION III MADE IN comFIJANCE WITH SAN 20AOUITY COUNTY DEVILLOPFAENT TITLE, CHAPTER 9.1110_3 AND THE STANDAPOS OF SAN JoA0tAIN COUNTY PuBUC HEALTH SERVICES. ENVIRONMENTAL HEALTH DIVISION. JOB ADORESSIOR AMP 4;162; "? / X CITY LOT .-2Z ,fra.-...r2,-?2,2 Arut OWNERS NAME 4 J.,•4‘.$ ,j1 • ADDRESS ,4242 PHONE .gds<-7.. CONTRACTOR /".a. "Id- Ay , <57,e..4 C ADDRESS ft) Rub CoNTRACTOR PHONE ADORES(' LIc PHONE LICS 9,7 TYPE OF scrtic WOW NEW INSTALLATION TEPAIRIADDITioN (NO SEPTIC SYSTEM PERMIT'S/ IF PUBLIC SEWER is AVAILABLE WITHIN 200 FEET OF BUILDING.) DEsTRUCTION PERC TESTIO I I HOW MANY Application / INSTAU.ATION w114 SERVS: RESIDENCE %I COMMERCIAL OTHER 0 NUMBER OF UvINI3 IN/101: I NUMER OF sEOROOMI• NUNIRIXI OF EMPLOYEES: SEPTIC TAPIKRIREATIE TRAP 0 TYPE/MFG ,•e_ri CAPACITY 1 L 60 CHARACTER Of SOIL TO A DEPTH OF 3 FEET: ejoGli P1T/SUMP SoIL cHARAc TER. e.jyyj WATER TABLE ()ERIN M3. COMPARTMENT:, 2. PRIG TREATMENT PLANT 0 DISTANCE TO NEWEST. WELL la) ' FOUNDATION 20 ' PROPF_FITY UNE LIFT 5041105 0 SSE TYPE OF PuMP RANI) OR SEPARATOR '(NCLOSED SYSTEM) LEACHING UNE la NO. A LENGTH OF LINES - 4 /0 ' DIST ANCE 10 NEAREST: WT(I. i eV ' FOUNDATION. 'W., ' FILTER RED 0 wooni LENGTH DEPTH DISTANCE To NEAREST: WELL MOUNDED 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL SEXPAC• PITS al DEPTH „-)s— ' SIZE 24.." NUMBER INSTANCE 70 NEAREST; WELL FOUND/010N PROPERTY LINT 3,e/ES'. SUMPS El WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY USE INIPOSAL PONDS 0 WOTH LENGTH DEPTH DISTANCE TO NEAREST: WELL PaUNDATION PROPERTY LINE I HERESY CERI1Ey THAT I HAVE PREPARED THIS APPLICATION ANO THAT THE WOW WEIL BE DONE IN ACCORDANCE WI EN BAN XJACILIIN COUNTY ORDINANCES AND STATE LAWS. AND RULES AND REGULATIONS OF THE BAN JoADUIN COUNTY. HOME OWNER oRLIcENSED AGENT'S SIGNATURE CERTIFIES TEl FOLLOWING: 'I CERTIFY THAT RITES PERFORMANCE OF THEINOTIK FOR WHICH THIS PERMIT TS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SURJECT TO WORKMAN'S COMPENSATION LAWS Of cALIFoRNIA.• CONTRACTOR'S HilsNo OR St1170DIXTRACTING SIGNATURE CERTIFIES THE FOLLOWING; 'I CERTIFY THAT IN THE PERFORMANCE OF THE Wolf( FOR WHICH THIS PERMS IS lawn), 1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN-19 CompENRATIGN LAWS OF CAJJFORNIA.• THE APPLICANT MUST CALL 24 Home IN ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPLETE DRAWING SELOW. PROPERTY LIFIE_, FOUNDATION PROPERTY LINE FOUNOA DON pRopERTY UNE WINED X PLOT PLAN tORAW 70 SCALE) SCALE I. NAMES OF STREETS DR WADE, NEAMETT To OR BOUNDING THE PROPERTY. Z. OUTLINE OF THE PROPERTY, WITH DIMENSIONS AND NORTH DIRECTION. 3. DIMENSIONED ouniNEs AND LOCATION OF ALL EXISTING AND pRoposED sTRucTuRes, INCLUDING COVERED AREAS 131./C11 AR PATIOS. OfsVELBAYS, AND WALKS. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C DATE A OR SUMP iNgPECTION Elle) r wo-ii DATE -7 //4 4, ZNAL INSPECTION a Acuff ioNAL CoSIMENTS ri., 4:i.. is 7-22.72 is_.e,9----_-4.4.)-e4a7-1T4.12 .-- 72 - ACCOUNTING ONLY: AIDS PALS SE CODE coDE FEE INTO AMOUNT RINI I TED cliEC112 ASH MOVED MN DATE SR 1 T NUMBER INVOICES /at 0 1/15'_ q -- & Ira PZI $;1 di Pub. Health Sent. - Enviro. 174 (3i96) •