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[ SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES I ENVIRONMENTAL HEALTH DION 304 EAST WEBER AVENUE,STOC9 ,CA 95202 (209)468-34201 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED . lCBmphh In Trblintol 1 APPLICATION 19 HEREBY MADE TO THE BAN JOAOUIN COUNTY FOR A PFRMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED.71419APPLPC M If MADE IN COMPLIANCE WITH BAN )DAWN)DAN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STAND�1ALfM OF CAN JOAOImI COUNTY PLnm HEALTH SERVICES.ENNRO HEALTH DIVISION. .f08 ADDIEssmk APN"ylty- ��/.Q Y, 51 cc,.CI'C��D • *'= CITY LOT MU-70YI oc OWNER'S NAME E 1 -C`f`.� VtiL�e l 1M e lAt JIbDREsls D i C e LN i / U'� V'Ca-L HE 32 V f A� SOLA LLxL -(�66``� 4F 1 CONTRACTOR C4.YY LIC( 0�4+?C1�1 AOOilE56 P Ll _ I NE i SUB CONTRACTOR ADDRESS 1101 E TYPE OF SEPTIC WORK: NEW nwOTALLAI/ON Q REPASUADDITION DESTRUCTION❑ `- ii IND SEPTIC SYMM PERMITTED IF PUBLIC SEWER 19 AVAILABLE WITHIN 200 FEET OF BUMDM.1 PERC TEBTW I I N IY _7 y� APPSaSaeb INSTALLATION WILL SERV£ RESIDENCE Yf COMMERCIAL❑ OTHER❑ NUMSE71 OF LUNO UMTa:____L_NUMBER OF KMROOMS: NUMBEIR OF EMPLOYEES! CHARACTER OF SOP TO A DEPTH DP 3 FEET: 5�,''s_- PITISUMP 6014 C14ARACTER:y/� �,f, _WATER TABLE DEPTH REPT1C TANKANWASE TRAP ❑r(PV IFG GU L- CAPACITY NO'..... PKG TREATMENT PLANT 17 DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LUNE LIFT STATON❑ SRE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED fYUMA) LEACH"LINE ❑ NO.B LENOTH OF LINE 6 DISTANCE TD NEAREST:WELL FOUNDATION PROPERTY LINE PH.TFR Bm 7a WIDTH LENGTH�Q! DEPTH DNTTANCE TO NEAREElT:WELLFDUNDATION D L PIgPERTY LINE_ MOUNDED ❑WIDTH LENGTH OEPTI- DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY LINE SEEPAGE vrFs �V DEPTH 62E NUMBER DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE SUMPS �11J--1 WIDTH FOUNDATIONRO LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LIN I.J E DISPOSAL PONOS WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WIELL FOUNDATION PNDPEATY LINE 4 I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK Wllt BE DONE IN ACCORDANCE WfTH SAN JOAOUIRI COUNTY ORDINANCES AND STATE LAWS,AND RIAJ:f AND REGULATIONS OFTHE SAN JOAOUIN COUNTY.HOME OWNER ORLICENSEO AGENr'f SONATURE CERTIFIER THE FOLLOWWO:ICER IFYTHAT 41THEPEW-DRWANCE OFTHEWORK PORYN9CH THM PERMIT 181f8UED.1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER At TO BECOME SUBJECT TO WOPKMUW'B COMPENSATION LAWS OF CAUFOTVGUL•C:OTITRACTOR'f HIRINS OR Sl1B-CONTRACTING URE CERTF1Ea THE FOLLOWING:h CE/TfiFY THAT!N 711E PERFOPASANCE OF THE WORK FOR WMCH TMf PERMR If EefllED.I BHURLL EMPLOY PEImONB SUBJECT TO WORKMAN'S COM BAT N U1WB OF CALIFORNIA.• 711E ApFUCAMT MUf7 CALL?•IID1816 RII AINANCE FOII Alt RFOLM£D INBP6`71oN6. COMPLETE DRAWING BELO/W. ' SIGHED X �- tTTLE: I'O GATE: � F ►L011'V W mMW TO SCALE(RCALE 'le_ 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED I 2.OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. - EXPANSION Of SEWAGE DISPOSAL$YfrEMG. 3.DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED 9TRUCTURE6. S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON • INCLUDIND COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADMINING PROPER". .... ........................ .. ... ............. - 'i ......i..... y a�ra�c.. 9y ... ........... ...:. :.... .... _ .. I ... l :... I �..' ... LJ '..... .... . �. :...., 1 .,c cv©owe. �I 1 ..,,.....o �,.... .. _ ... j1 _ ... ... - t ... ..,. kZ Ib... �.. . ..:. .... ¢. .... L... � C y. Lab :. ' _.......--- PLIEUC HE AL7r1 5_AVlCC,. FOR DEPARTMENT U9LOATE: / NMEWl lH,n,'l-Lr H UIYISI�:.. APPLICATION ACCEPTED BY ^'�1.' AREA! _-- TANK,PN OR SUMP INSPECTIO BY DATE I ! NSPECTION BY DATF�ADDITIONAL COMMENTS: Q� ff ACCOUNTING ONLY: A1DF FACA "'1�jU J'J ,� PE OWE FEE IIIFO OVNT ROMIIYF]7 H.. ABH PEC Y DATE M I P'E91TIT NIABBER INVOICE 0 Pub.Heats Sere.-EEnvlrD.174(3195