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+ SAN JOAOUIN COUNTY PUBLIC HEAEAyICE3 f ENVIRONMENTAL HEALTH 41'. ,N P,O,90X 388 304 EAST WESER-AVENLirm,STOonom CA 95201388 (2091409-3420 { NUN•FFFUBI]ABCE PERMIT EXPIRES 1 YEAR fR6M RATE ISSUES t� [•fq/� ..py(� (Compipto in Triplicate) APRTCATKRN I9 HEREBY MAGE TO E, WIN CO VNFY FORA PERMIT TO CONSTRUCT AND10R MST ALL THE WORK UESCWBED.THIS APPLICATION le MADE IN CDMRJANCE WITH SAN MAGIAN COUNTY DEVELOPMENT TIRE.CHAPTER 9-11 M3 AND THE STANDARD OP SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION- (^�� CITY LOT SIZE { JOE ADDREBSIOR ADN/ OWNER'S NAME -A— S�'C ADDRESS ,f /�/�S 7 T+PHONE/ /'� CONTRACTOR /6., W� (2G/ PHONE G � /7 Imo, SVB CONTRACTOR ADDRESS uCI PHONE i TYPE OF SEPTIC WORK: NEW INSTALLATION MPAIRIADdTION❑ AFaYSVCTION❑ piO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AV )LIABLE WITHIN 200 FEET OF BUILDING} FE.: M I 1 NOW MANY • �^ INSTALLATION WILL OERVE: RESIDENCE P COMMERCIAL❑ OTHER❑ NUMRER OF LMNG UNITS; ( NVMR91 DF BEDROOMS'��NUMBER OF 9JIPLOYFES: C R OF SOR TO A DEPTH OF 3 FEET: 7k QIa {�T{dl1MP SOIL CHARACTER. GWATER TABLE DEPTH TTC K10REABE TRAP ❑1-YAJMFG -Sae:dt-7f CAPAC i7-C?O 04-1, NO.COMPARTMENTS .. T� PKO TRFATMEIT PLANT Q ITISTANCE TO NEAREST; WELL g�ef f FOUNDATION O� PROPERTYLINE UFT STATIDN O IBZE TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM) r Z S ! ° LEACHING LINE f NO-k LENGTH OF LINES T �-,L1--� DISTANCE TO NEAREST:WELL S�©O r FOUNDATION ZS' PROPERTY UNE FILTER BED ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:Rr/FTL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH e-T DISTANCE TO NEAREST:WELL FOUNDATION / PROPERTY LINE , yy __Jy DISTANCE TO IJEARESi:YMELL ////��++D I FOUNOATI.N LP I PROPERTY UNE } SEEPAGE PRE DEPTH .•612E &t r1 NUMBER -7�-- I SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE t DISPOSAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES AND STATE LAWS,AND RULED Oft AND REOLIU71bNe OF THE BAN JOAWIN COUNTY.HOM ER ORUCENSEO AOENT'SSIGNATURE CERTIFIESTHE FOLLOWING'ICERTIFYTHAT INTHE PERFORMANCEOF TNEWORKFORWHICH THIS PERMIT IS ISSUED,I SHALL NOT Y ANY PE,Re N M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF ,I SHALL A.EM CONTRACTOR'S HIRING 10 SUB-CO SIG AT C I ES FOLLUWI :9 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED.I SHAM EMROY PERSONS SUBJECT TO WOR( AN'a COM 10 S C T MUST CALL 24 HOURS IN ADVANCE FOR ALL RED UI ED INSPECTIONa. COMPLETE DRAWING BELOW. TIRE: DATE- w 7 T-� MNFD ROT PLAN tDRAW TO SCALE)SCALE 'I° 1.NAMES OF STREETS OR RDA ST TO bR BGVNRJINO THE PROPERTY- 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2,OUTLINE OF THE PROPERTY.IN DIMENSIONS AND NORTH DIRECTION. EXPANSION F SEWAGE THIN RAL SYSTEMS. 3-DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6.LOCATION EPROOF WR A WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. OIOlNING PROPERTY [[LP^+ THE PROPERTY OR A, -------V :.... ........ -.-... t .. .... ... ._. J .. .. ..o ... - ...... .. ...... . ...... ..... .............. .............. ..... ........... ......... ...... ... ......... Vp rto L �1 C ¢. :.... ¢.. 4. AUG 2 ..199 ... ...... t_= -_ . __ SANJ QURN CO .. .. RONWN A tc,AE�ESi .rt _ ENVi ALT' C FDR DEPARTMENT USE ONLY DATE: ,� + AREA:. . r y APPIJCATIGN ACCEPTED BV I fJ J�L� DATE I I FINAL INSPECTION Sy_ TANK,RT OR SUMP INSPECTION BY � , ADDITIONAL COMMENTS: ACCOUNTING ONLY: AIDS FAC,► DECODE FFFINFO AMO UNT RFMII TEO REC !CASH RECEIVED BY DATE SIR RPBSUDT NUMBER INVOICE/ _ 4� Pub.Health Seem-ERviro.174{3196} L