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— nwru mr.nry r rrww•wu� vwlr roovLe (Coraplato Li Tr�IIExBtel APPLICATION IS HEREBY MADE TO THE SAN JDAOWN COUMtY FOR A PERMIT TO CONCTRUCT AND/OR INSTALL THE WORX OEecR13E0. THIS APPLICATION 18 MADE IN COMPLIANCE WTTII am JOAOVIN COUNTY DEVELOPMENT TITLE,CHAPTFJU 0.11 10.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH VERMICES,ENMW AM ME NTAL HEALTH DIVI®,ON. JOS ADDREeeroR APW Z 1 Z•S0 C 1"}1� ��_. CITY Q-0 r C,� _ LOT SIZE /-'/y /AG r owwwo NAME NA^2a �ArhAOORESI Z i Z 5 lr• i ADA r.J ft c_�u tjoo 4 Cd FIIDHE ..-- ONTRACTORJJCi V• q�.+UC:RScsti1�. —� ACLS' 1� v �.ham'-• AIIDRES6_�Z T�--a.s7yr--�c.,u, AICA' �RMDNF 3h�-T- 37` / eL13CONTRACTOR k5 p-S�-� S:r.�►ceK �e11;aDORfse7 t 1 t�1, �6/u+� RA�IT I�r�uci PHONED[�� TYPE OF an,=WORK: NEW INOTALLATIO REPADVAOMTION ❑ DEATNCTION❑ NO OEPTIC SYSTEM PERM(TfED IF PIh1LIC SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILIMNO.1 Pme TaOTIVI I 1 Now MANY AIN"I�BeR i TVI �Lel+3—�IG tNSTALIATRON WILL EBTVE: f•£SIDENC� COMMERCIAL❑ OTHER❑ NU NCEit Of LFANO UPRTB: NU MZCI OF CWROOMG: NUM3HI OF 6NPL0YEED: CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PITISUMP SOIL CHARACTER: WATER TABLE DEPfH_ SEPTIC TANKt=XABE TRAP ❑TYPEMFG� CAPACITY NO.COPA/PARTMEIITB FICO TMATMENT PLANT D DISTANCE TO N mmr: WELL FOUNDATION PROF43ITY LINE i LOT OTATION❑ SIZE TYPE OF PUMP BAND OIL SEPARATOR iENCLOSED BYSTEMI LEACHING UNE ❑ NO.G LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE r RLTGi DED ❑WRDTN LENGTH__DEPTH DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY LINE I MOUND® D WIDTH LENGTH _DEPTH ONSTANCE TO REA EBT:WELL _FOUNDATION PROPERTY LINE OEMAOE FITS ❑DERTH 812E .NUMBER DISTANCE TO NEAREST:WELL___FOUNDATION PROPERTY UNE CUMPO ❑WIDTH LENGTH DEF FH DISTANCE TO NEAREST:WELL_, FOUNDATION PROPERTY tim OOOPOGAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATON PROPERTY Log C) I' I HEREBY CERTWY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH GAN JOAOUNN COUNTY OFMINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAOUIN COUNTY.NOW OW NM OR LICENSED AGENT'S SIGNATURE CERTIFIED THZ PDLLOWING:'I CERTIrY THAT IN THE PERFGROAANCE OF THE WCM FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER.A8 TO BECOME SUBJECT TO WORKMAN'*COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR-0 HMM OR SUB-CONTRACTING SIGNATURE CERTIFIZO THE FOLLOWING:'1 CEW"THAT IN THE PERFORMANCE OF THE WVAX FOR WW50H THIS PERMIT 10 IOCUED,1 CHALL EMPLOY POICONO BLgJECT TO WORKMAN'S COMPENSATION W0 OF CALIFORNIA.' S NIA' THF APPLICANT MT CAL%24 NOUPI IN ADVANCE POO ALL R1CGU=CD FI:-PCBTIOKO. COMPLETE ORAWRRR BELOW. SIGNED X - TT'LE: � C IZ DATE: TTl�ddd F" PLOT PLAN 1DRAW TO SCALE!SCALE 'Ie 1. NAME8 OF STREETS OR ROADS NEAREST TO OR BORN DM THE PROPERTY. 4. LOCATION OF WKM CEWAOE DICMDAL SYSTEM OR PROIOOEO 2. OUTLINE OF THE PROPERTY,WITH D=ENCIONO AND NORTH DIRECTION. EXPANSION OF DEWAGE DICPOSAL*MEMO. 3. DIMENSIONED OUTLINED AND LOCATION OF ALL EXIOTOM AND PROPOSED 8TRUCTURES, S. LOCATION OF WELLG WATKX RADWO OF ONE NUNDIEO FWrY FT,ON INCLUDING COVERED AHEAD SUCH AO PATIOS,DIOVEWAYO,AND WALKS. THZ PROPERTY OR ADJO69NIG PROMATY. ' ... .. ...... VICINITY MAP (( IIWf 321J nL[L+wN RD ! HOXu[Y RD °ate PNUD MO y K IIWJQ Ica ■ y 2664.33 ----------------------- ..__.------------------------ 40 __---_-_____-____- . . . -- -------------------------------- '3-70 -----------------------3'IO r REIIAINOER 7-4.10t�.a_ Jas ' .�.+�(D I RL PAACFI I_ �. r 44W A- - „oa abS4.V3 PLG 13 SAN JOAQ01' a f PUBLIC HCAI.TI �y:�:� FOR DEPARTMENT UDE ONLY APPLICATION ACCEPTED BY DATE: r Z, TAW,PIT OR 8U"P INSPECTION BY DATE I I FINAL INSPECTION BY C� SATE