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k.IGcni Tt:AR 4 'D i! i L" 'rr+i�1V1A <br /> TS9 • APPLICATOR N HEREBY MADE TO THE SAN JOAOIAN COUNTY FOR A KFWIlT TO CONSTRUCT. R MSIALL THE WORK DEBCRNED.THIS AFPmATON IS MADE IN COMPLIANCEYVITH SAW <br /> JOAOUN COUNTY DEMCiPMENT TITLE.CHAPTER 9-1110.3 AHO THE OTANOARDS OF SAN JOAOt/RJN C-OyOANtY PUSUC HEALTH S�ERIACCES.ENVIIONMENTAL HEALTH OIVIBION. <br /> .1011 All"661VII APNF- O . Q/I W1 r/C /_�• crr f .�^-1r.L - ___Lot B7p p� <br /> OYIHEB'E NA•.!�� ��+L ICCCl1'lQ _ A..B t 1 -�'"-` 9 ('PHONE 17 <br /> CONnLACTOR ,JV�(J1�"fUY>. Sia G __ADbR[SO . Cll wtc�ir�/ a• �Y'� LtCf G�J NONE K� '�7 �� <br /> BU.CoTm4LCToR AobRltO LIC* <br /> TYPE OF SEPTIC WORK: NINP INFTAUAMN❑ NEPA11VAdpTO DPATBHCIIOM❑ - - <br /> WO SEPTIC SYSTEM PERARTTEO IF PUBLIC.EWrh IO AVAMBLE Y1rTHM 2OC FEET or gwtiaol PDe4 7TSTHI 1 F MHN MANY <br /> � :� y APP.-.P <br /> derMu»GW wlu reRrE: REemENeE d cGMMEncIAi❑ OTIfER❑ .0 y1LJA. <br /> WWRER OF LrANO UNITS: I NUMBER OF EEDROOMS: aRLEYv OF BI:IPLOYEES: _ r <br /> CH OF BOO.Tb A OFPTH OF 3 FEET A FIT P SOR cNARACTER. WATER TABLE VEPTH�-7 <br /> SEFTIC T E T11AP O TVPEIMF �^ CAPACIT T^NO.COMPARTMENTS 1 <br /> PR 71.IENT PLANT❑ DISTANCE TO NEAREST: WELL I5- t FOIGJOATION Lr7 / 9ROVERTY LINE Ta <br /> UFT STATION 11 ATE TYPE OF <br /> a@ANO OR SEPARATOR IFNCLOBEO OYBTFMI <br /> tFACNMG UNE )K NO.B tFNOTH OP LINES i_IOd r/DY 11L. dSTANCF TO NEARESTx N1E 62-FOVNDATION��FTIOPERTY DNF.��� <br /> "LIM BED ❑WIDTH LEROY" DEPTH 089TANCE TO NEAREST:WELL FOUNDATIDR PEOPERrI'UNE <br /> MOAMOED L7 vMOT11 LEHOTH DEPTH DISTANCE TG NEAREST!WELL FOUNDATON PROPENTY LME <br /> SEEPAGE RTS DEPTH SUE NUMBER DISTANCE TO NEAREST:WLLL FOUNDATION PROPERTY LINE <br /> SUMPS O WIDTH LENGTH DEPTH OTSTANCE TO NEAREST:WELL POUNOAT'LON POMotV LINE <br /> dSPOEAt,PONDS O WIDTH LENGTH OM14 DISTANCE TO NEAESTs WELL FOVNOATOH PROPERTY LME <br /> f HEREBY CERTIFY THAT 1 HAVE PREPARED TWO APPUCATON AND THAT THE WOM Nell BE OGRE M ACCORDANCE WITH SAW JOAOUFN COUNTY OIOINANCES ANO @TATE LAWS,AND RULES <br /> AND REOVIATIONSGP THESANJOAMN COLPHTY.HOME ONMEH VMV AGENT'S WONATURECERTWIFSTHE FOIIVWMI'ICERTIFYTHAT M THEPEIMOWANCE OF THEWORK FORNSBCN <br /> TMS N 19WEO,1 SHALL NOT Y ANY PERSON M FUER AS TO BECOME SUBJECT 1'O VYORWAW10 COMMN@ATO"LAWS OF CALIFORNIA.' CONTRACTOR'S Mttlllp OR l <br /> SVe 1NG RE CE B T FOLLON9NO:'1 C try AT M THE PERFORMANCE OF TIE WORK FOR WHICH THIS Ptz IS ISSUED.I SHALL EMPLOY PERSONS SUSJECT TO J <br /> WO MANE ATO F C A.' ANT ST CALL SI Ib111U IN AOVAMCB FOR ALL <br /> R.EM-y1�1t�jRm INSPECTIONS.COMPLETE DRAWMO SEIOW. /rte , R <br /> x TITLE: �LW' • _-_ _DATE: X L�J <br /> (/ Q <br /> PLOT PUN(DRAW TO SCAM OCALE -fn <br /> T. NAME.OF STREETS OR TOADS TO OR eOUHONG THE PROPERTY, 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OV"JNE OF THE FROPERTY.WITH vIMENOIONS AND NORTH DIRECTION, EKPANSON OF SEWAGE DISPOSAL VVITFMB. <br /> s.ONAENSIONED OUTUNEB ANO LOCATION OF AIL E%ISTMO ANO PODPO9ED GTRUCTURFS, S.LOCATION OF VJEIlS LVITHIN MDNS OF ONE HUNDRED FIFTY FT.ON C� <br /> WCLVOMG COVERED MEAS SUCH AS PATIOS DTSVEWAYE.AND WALKS. THE PROPERTY OR ADMOSHO PROPERTY. l5 <br /> .. .. ....- .- -'.. .., .... L .,, <br /> C` z. <br /> v <br /> . . . fat erL�°.c.�emc� i raL LLS 2 ioo' .. <br /> . �.... .... .. .� . . ; 4.... ,ti-� i �.nom;�•�r}� �4 .LL�.: <br /> i.< . v... <br /> ... .... .:.. ..... <br /> :.. <br /> <: P MENT ....'..... . <br /> .., <br /> :,t� SSP 81986 <br /> ►. <br /> �r ` <br /> Sh1140 fl %JJ'VfY- <br /> REM <br /> 1JDec� � r�ENV! <br /> 9LLCHFIV(, HaF,tl4ICE9 <br /> fbiv !YL fAll hi UIV15k]! <br /> i <br /> FOR DEPMTAEETIT USE ONLY <br /> APPLICATION ACCEPTED BY pATF: 9 AREA: <br /> TANK.PIT OR BUMP INBPECTION.Y/��I r- ///1DATE 1 1 FMAL MBFFCTVON NY DATE/K/1MI11V <br /> ADDITIONAL COMMENTS: L f!1 ,S!J"'� P11 14 1.r1 R )00 ,9-f ;A, <br /> ACCoUNTMO ORLY: AWE FACS <br /> R CODE FEE RIFO AMOUNT RIUMITEO (rIIEC RECHVm SY DATE SR T PERROT NUMBER INVOICE <br /> Pub,He9Rh Sem-EnAro.174 13198) <br />