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_- - --_... _....._....... .___..-......... .................,.�. ,,.�....,....�.,......,�... ....�...,w..,,.....o.v+nvc.,...a....ry nrn.c min ann JO,IQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. 2� JOB ADDRESS/OR A��PNI 4 r� ! yt,T 2 j� , I CITY �C�r.1�JJ r1L• LLOT SIZE `LVA ✓ D� OWNER'S NAME c/ ADDRESS Pa 1 J� �")`7-1 �(� .�' PHONE )� / T-1 q s CONTRACTOR C l./IJ��LT ADDRESS (�/`--rLjZ, ej LIC# : PHONE SUB CONTRACTOR ADDRESS LIC# PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIR/ADDITION ❑ DESTRUCTION ❑ (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEINER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) ►ERC TEST(91 f 1 HOW MANY App"don# INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 11 OTHER [3 NUMBER OF WINO UNITS: NUMBER`OF■ OOMS: _ NUMBER OF EMPLOYEES: C� CHARACTER OF SOIL TO A DEPTH Of FEET: Ca.- PIT/BUMP SOIL CHARACTER: L. W TER TABLE DEPTH rJ 0 �7t SEPTIC TANK/OREASE TRAP ICJTYPE/MFG C041C rC CAPACITYJ ZLL� Ca Ct,C NO.COMPARTMEMB PKG TREATMENT PLANT❑ INSTANCE TO NEAREST: WELL ` e6 FOUNDATION PROPERTY LINE C UFT STATION❑ SIZE TYPE OF PUMP $AND OIL SEPARATOR(ENCLOSED SYSTEM) R LFACHNO LINE NO.•LENGTH OF LINES 2X -70" DISTANCE TO NEAREST:WELL FOUNDATION_PROPERTY LINE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL - FOUNDATION PROPERTY UNE MOUNDEDt❑WIDTH_LENGTHS f_DEPTH DISTANCE TO NEAREST:WELL FOUNDATIONU _PROPERTY NE SEEPAGE PITS YJ DEPTH�2 `T SIZE A NUMBER_ — DISTANCE TO NEAREST:WELL O Ir FOUNDATION_lPROPERTY LINE 6UMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CONTRACTING SI&T CERTIFIES THE FOLLOWING:'I CEifTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COM TION LAWSOF LIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTION!. COMPLETE DRAWING BELOW. C" SIGNED% - L TITLE: DATE: PLOT PLAN(DRAW TO SCALE)SCALE 'to f 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 1 3, DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WfTHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,,DRIVEWAYS,AND WAIXS. THE PROPERTY OR ADJOINING PROPERTY. .... .... .. .. ........ ... ...... . ..:. ..;. ..:............. .. .. .. .:... et ... ....<.......... :..... ....... . ...... ...... .. .: ..:.. . .. ... .:.. ....:...... .. . ell .. . . .. .. . • : .................... . :. .. .. J i ..; .....:... ..:.......: ....i..... ... ;.. .: .. ...:.............;... .............i.. .:..,..: ............._. ....i....J.......E........�?..............E.. .... .... .. ........... ........'..... .... .. . ......... ...... .�. N. .....9.� 1 1 .; .. ........ i i / ! h` r 1111.V 1 1 h i iE.A-L L iES . • _. _ ..iA .... ............: .......... y.. .. _ .. .. .. .. .. .. .. ..........:.... V, �Yl FOR DEPAATM EN USE APPLICATION ACCEPTED BY R �,ti ^ DATE: l AREA: TABIC!PX OR SUMP INSPFCTIDN RV�Y/i� //?WLI�'L/ PAT[4/ AZ L i 7 7r]MAI -coc7- v lip -0/0/1,,17 01.