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t / V C�j Z-/Y-/r c?-- 7,j e / (CBmplata in Nplieata) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/CIR INSTALL THE WOFX DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE, <br /> CC.'HAPTER 8-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> -a'Cn/�"'/�'-4 Z+�Y liGI CITY 41tl,Ci EPS LOT SIZE <br /> ' JOB ADDRESSIOR APN#1 AA <br /> OWNER'S NAME 7'01�i'l f�6"t ADDRESS .SAi'y (may /� rl p� PHONE <br /> CONTRACTOR 4/—y ',k,,!F, ��'A� ADDRESS�0.41 6 42'rCt Lx, 7�7 Al PHONE <br /> a� <br /> ' SUB CONTRACTOR ADDRESS UC# PHONE <br /> TYPE OF SEPTIC WORK; NEW LNSTALLATION S REPAIRIADDITIONI ❑ DESTRUCTION❑ <br /> d <br /> WO SEPTIC SYSTEM PERINITTTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDINGJ PERC TESTW I 1 NOW MANY <br /> ' /,� AppScatVort <br /> SIEVE:WILL SVE: RESIDENCE C3 COMMERCIAL❑ OTHER 138 QOd vi-00a' HEMP f7 ��',, p��r�q •� <br /> NUMBER OF LIVING UNITS:_NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES �7 ( <br /> CHARACTER OF SOIL TO A DEPTH' OF FEET: 114�rOl PIT/SUMP SOIL CHARACTER: •JA lVd WATER TABLE OEPTH ZIA SEPTIC TANIUGREASE TRAP .0 TYPEIMFG "Ogre C1051' I't{'C CAPACITY /x n d NO.COMPARTMENTS A% <br /> PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> UFT STATION❑ StZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) 7 <br /> LEACHING LINE 0 NO.&LENGTH OF LINES A - r DISTANCE TO NEAREST:WELL It CO FOUNDATION /�°• PROPERTY LINE <br /> ' FILTER BED ❑WIDTH LENGTH - DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE_ ys <br /> MOUNDED ❑1MDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> SEEPAGE PITS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMPS AI WIDTH A� LENGTH J�d DEPTH �7� DISTANCE TO NEAREST:WELL FOUNDATION 1e' PROPERTY UNE m <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE lV� <br /> 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 <br /> AND REGULATIONS OFTHE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:PI CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT 16 ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER A6 TO BECOME SUBJECTTO WORKMAN'S COMPENSATION(AWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENNSA71ON LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 POURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS, COMPLETE DRAWING BELOW. <br /> SIGNED X ILr DATE: <br /> ' PLOT PIAN IDRAW TO SCALE)SCALE 'to <br /> 1. NAMES Of STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.OH <br /> ' <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS AND WALKS THE PROPERTY OR ADJOINING PROPERTY <br /> ... ..... . '. l..... ....... ...... >... ......: <br /> ... ...:... . .. <br /> - <br /> _ Ap j <br /> e <br /> ... <br /> ...:............:... . <br /> : ; . <br /> :. . lyos�tL L..A.............. <br /> 1 <br /> .. C` y <br /> .......:................... .... ...:..I s:6f.Iy�... <br /> .. .. - <br /> ...::............. <br /> o. <br /> �.j <br /> ...:.....i.......' <br /> .. <br /> • <br /> • - ...... <br /> : <br /> I< <br /> ..... ;. ..'.... ... .... .0...... .... ... y .. .....j... <br /> 1 <br /> .:.......�... ... v <br /> ....... ............:.............. . <br /> .:...........:..... <br /> ...�7J.!.. .;. <br /> ......I............'. ....i.... .. <br /> .....'..... .. <br /> Zi <br /> .......... <br /> . . . ... ... ... ... <br /> cNV'A L <br /> :.....:.............:. ..:... <br /> .....;..............:...................:..........s.... c?fT4 �tE <br /> . .���ICE <br /> :.. <br /> . .............,............,....... ..:.... <br /> _.. _ <br /> :............:........ ....:.. . . ......... <br /> . <br /> 90 . <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE: © ` AREA: � "* ' <br /> l},�' DATE ! ./FINAL INSPECTION BYak�tgDATE// 2LAr- <br /> 6AN?,PIT OR qunyP INSPECTION BY jd <br /> ADDITIONAL COMMENTS: - o <br /> ' ACCOUNTING ONLY: AID# FAC# <br /> PE CODE FEEIN AMOUNT REMITTED EC ASH RECEIVED SY DATE SR I PERMIT NUMBER INVOICE# <br />