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<br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES y
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<br /> ENYIRONNfENTAI HEALTH[]iVfSIO „'-
<br /> P.O.BOX 388,446 N.SAN JOAQUIN ST STQCI(T4 A 96201 8 s .art
<br /> {2091 d8B-3420 ' s" r.,b is�,
<br /> I 1 ` rDr REFUNDABLE PEPM]-T"E1tPIA#1 1 1' A*,FIDM„�TE IStUTG `'_d ti �. x� , '
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<br /> y W Appltesttoni',I hereby made to the San Joaquin Caknty for a permit to corrafr�xb±nd/or lnst-Ii the rork'deser(bed iThfs'applteetion '
<br /> I! made in compliance with San Josqufn Coon+.y vevel Anent Iitia, chapter.9.1110.3 and the cr-ndsrds of San Joaqufn Canty Pt�ifc xealth
<br /> Services, Envlrornrntal Nealth Divesion, , ,.,
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<br /> Job'Address/or AP1tN `-c 9.11 � alis?,,, � f2 1 — City,�[�CJ�'t�72*�i2 let Sita � "Y�_1��
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<br /> ;G TYPE OF IEPTIC WORK. NEW INSTALLATION[1 ., .-11EPA1RIADDITIDi1 Ef " DESTRUCTION 1 I SERC TERT(al I 1 Neva rnT «�
<br /> '' '' v m tk0 SEPTIC SYSTEM PERNItTED IF,PUBLIC SEVER'IS AVAILABLE V TN1r 200 FEET Of BUILD100 3 V;: r r" }.'
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<br /> 4` , " Inotaltat[an velli serve Resirlence eoerrnercial� Other :' ;k, .
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<br /> k- yisr ;�, r -' Nufier,of llvirW..unEtat :Ruebsr of b�droomar" Nurtber_of:rmp�ayeaat " ° `� j*r wL'
<br /> �§p� Chrractar of sol!-to'a depth of,3 f.at� �i1•- Pit/Burp Solt Charactara = Vttar iabtr Dapth � '
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<br /> ;r f'c �,h P1rD TRTATMErTPEArT C ).:.Dfstance'to nearest �Velt _ fotndatian _� roperJty line ``x`
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<br /> _ r F� 1.I" ,',' DEFT STATIOiI[1 Stte '.Type of Pury Sand:01I Separator (enetcaed aysfeti) �F - �� `" �" '-
<br /> e_ €'�; "' }� LEACNIrD EINE of i No Y length,of ItnesT/SSS'' Distance to.Nearest 'Nell /S�rt Foudation �� Property lftr� {rte
<br /> a{ _L ' "�j R: Width Length Depth �� " Nell FoLrasrion r ' Property Lll+e , `•
<br /> l .444 ose �^ FILTER i<ED 5 U r S �n
<br /> '1 G '"`' �'�'I '-NIDDrDEO '- I Width -Length Depth `1. ' " ;Well fayitdatIon � Property llna '°'t'�"�-
<br /> i� ` :sr, khy j, i .. n Vei! ~r Fourdatlor err PrnpertyCitM�Sa- --+. ".
<br /> W fy i i lEEPAOE PIT/ D) Depth'_ S fete 31G _ 1(urber l{� ---
<br /> '3"a F ., ;a _ _. 5.�r t 2 x 5-,e s, a*Y,N7 o f
<br /> A X �Z,;sIC` 4 i ,' RUEIIPR , '(1 V{dth Length Depth . Yell foundetlxs �PropertyLfrx- i .tom:,
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<br /> LLLLL �: ` r •-Nell Folxods r IoR v Pr rt t[n! ' '
<br /> T�g,� 3sa DIRpOYALPDNDR, [) uldth LeWih Depth r. .<„` a. k Lyac 5,f cr1 .
<br /> Y�"`• ,r:, ��+�' '•hheretry certity,that-1,hwr preparW.thfa'applfcatioe'and that-the.wark witi,be done.ln,accardanae,with',Son•Joa¢rin•.Canty Ordlnarte
<br /> s ;I`"'r s b end State Laws;-and Rules:ard Reguletiona of the San'Joaquln County.'-Noise.owrer,ar,licensed epent`:r_algntituie eartiflea the olLari )
<br /> •I,;certify:that:in the:performence ot:the warr.for_wfiich;thie penoit;is,iasued I''shatt not eaplay any.peisoes ln_'tueh a canner a :�`:
<br /> �- .to:6ecasee:isibJcet tu,:wortnenrs;'cornpensatSon iews:of;,CatIfornia ContractoNs hirinp;or serrcontraetlnp'slpnrture etrtiflsaythr� a;.
<br /> � �� i r ,�� ;--'foltbwlrig:':"1:,certliy,that'.[n':the'performencc of tht`vork for which this permrt is Issued L scall employ persons st�Ject to tirorbJNalz�^
<br /> rs s C coapensatlon laws of.:Callfomla ” - d . ser b a
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<br /> Y - f `5 � �e _,'The applissat*oat oar Z ens is a!rinu, aD r ulnad inspwiiras Coaplete draw[ng bttow, -, - r r k£
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<br /> £ G Locetlon of,shoena aewage�dlapcsat
<br /> LL- r-s ,*,9 r-n 1 :Names of atretts or roads nearest.,to or,bounding'the property
<br /> _ 2 with'd{mensiont.and 1lorth diractlan proposed expuulun"of sewapa diapafalrayatatr�� "
<br /> .,f�Z� , t 2, "3 p tmrri9I&4d autIInne2r.,.M_locatIan of all exlatinp.and proposed "i :Cocetlwt of;;wella within radius ;�01011
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<br /> I`"",,,,,,rr x a rK)3 stnicturas "Incl reintr,co✓ered arras such as patios driveways w the property or ad]aln[rrp propirtAF r:+i'.,rh._ * a'' G:�t�and waifca �",y i '-`�'� ..f- - r v-'Y. 11. " ,e d` {� ''�7 'X ia�'1
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