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SAN JOA041�I 1UNTY PUBLIC HEALTH SERVICES ENYI ENTAL HEALTH DIVISION I P,p.BOX 388,Z3 01 EAS, .JEBEFt AVENUE,STOCIMN,CA 95201386 E 12091 189.3420 NON-REFUNDABLE PERMIT ERPIRES 1 TEAR FRIXM BITE ISSUED ' RompkIs in TrI Nevi&) - APPLICATIOH Ie HERE$V MAOE TO THE SAN JOAOVIN COUNTY FCR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOFTL DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WITH BAN JQAGNN COUNTY DEVELOPMENT TrTLF,CHAPTER 9-1110.3 AND THE STANDARD&OF BAN JOAQUIN COUNTY MaLIC HEALTH SERWCES,EHWMNMOrtAL HEALTH DIVISION,. JOB ADDRESBIOA APNI CITY OWNER'S NAME Loi SIIE�((Z .J DOnEss PIONE�_ . COMRACTOp BUB CONTRACTOR AGGRESS LlCI c R1ONE TYPE OF SEPTIC WORK: NEW INSTALLATION 13 REPAIRMD04TION q t.—TRIUCNDN❑ - _ Ia■■{^ _IND SEPTIC SYBTEU PERMITTED IF PUBLIC SEWER IS AVARAKE WITHIN 700 FEET OP BVILD50O.1 FERC TUTHI I T HOW MANY } } IW E�1 ❑ r-1❑ APPIwBnn I - INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NI.MBRI OF Lm Na UNITE: 2 NLT.IB91 OF BEDROOM;;-- y NUMB;OF EMPLOYEES, CHARACTER OF SOR.TO A DEPTH OF S FEET: i'/er. piTIsump SOIL CIMRACTER: WATER TABLE DEPTH_, SEPTIC TANPUOREASE TRAP ❑TYPEMNFD. - CAPACRV NO.COMPARTMENYB N ACO TRFATMENT PANT❑ MSTANCE TO NEAREAT; WELL FOVNDAIMN PROPERTY LINE - UFT STATION❑ STLE TYPE OF pVMp- RANO OIL SEPARATOR IENCLOLED Sye T(M) �/ I� LFACNNO LINE NI NO,s LENGTH OF LNES40• DISTANCE TO NEAREBTI WELL_J�_FOUNDATION- l�PROPERTY UNE FILTER am ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL WUNDATION PROPERTY UNE 1■'' SEEPAGE PET! I�DEPTH 'J _6i;E� �NUMSER� y� DISTANCE TO NEAREST:WELL_JQ FpUNt)ATCON. !gL• P QPERTY LINE 7S sumps ❑N4QTH LENGTH DEPTH DISTANCE TO NEAREST;WELL FOUNDATION PROPERTY LINE DIFIOeA[POMOB ❑WIDTH LENGTH DEPIN DISTANCE To NEAREST:WELL PoUNDATION PROPERTY LINE_ I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOW YYB_L BE DONE IN ACCORDANCE NRH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND AVLES ANOREOULAIMMs OF THE BAN JDAOLAN COUNTY.HOME OWNER ORLICfNSFO AOENT'B SIGNATURE CERT3FIES THE FOIJ,N OI'ICERFIFY THAT IN THE PERFORMANCEOFTHENVPK FOAWHICN .1 TH[B PERMIT IS ISSUED.I WALL NOT EMPLOY ANY PERSON RN SVCH A MANNER AS TO BECOME SUBJECT TO""MAN'S COMPENSATION LAWS OF CALIFORNIA.-CONTpACSOR'S HIWNQ OR C" C7T ' SVS-CONTRACTINO BIGNATURE CERTIFIES THE POLLOWINO;•I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS CEAMIT Ie ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO V`OWMAN'S COMFEHSAtION LAWS OF CAEIFOryMA.' THE APPLICANT MUST CALL 24/LOURS IN ADVANCE FOR ALL RSOIARm INSMCTION/. COMPLETE DRAWLNO BELOW. SAFNEOx „'••.• •.. :` TITLE:_ GATE: PLOT PLAN(DRAW TO SCALEI SCALE I.NAMES OF STREETS OMROA98 NEAREST TO OR BOVNDTNO THE PROPERrY. _ {.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED Z.OFMENM NEDOTUNEOF THE PROPERA WITH OCATFODIMENSIONS OFALLAND NORTH WR¢c7TON EXPANSION OF SEWAOf DISPOSAL SYSTEMS. - -].ORMENBSONEb OUTLINE&AND LOCATION OF ALL E%1671NO AND PROPOSED STRUCTURES, S.LOCATION OF VKtkB WH`HTN RADNS OF ONE HUNDRED NFry FT,ON 1NCLVDINO COVERED ARFAB SUCH AS PATIOS DRIVEWAYS ATA WALKS -- ....THE PROPERTY OR ADJOIMONO PROPERTY. ....... ... .. ......... ......,; ..a. .... ...... .1 .... ° ..... ^ ..... ...... " ..... .......... .......... .......... ........... .............! .................. ... ........................... c .......... O e trF�- n �99I V1ft I IEltL,? . . .,....v 1vh1f l4 .... .:.,....:.. ?�. ... ..,.... ' FOR DEPARTMENT USE ONLY �[ AWJC(/A`TI.ON ACCEPTED ELY DATE: AREA' PoTTOR SUMP INSPECTIOI{BY r DAFE1 r ( FINAL rNSPE[Tgry Sy 1OATE S I AVOtTIONALCOMMENTe: • r ACCOUNTING DNLY: MIDI FAG PE CODE FEE INFO AMOUNI REMITTED G;IEC AS AECEIVm eY DATE NI/EMIITHUMe91 INVOTCEI Pub.HBBRh Sam.•EnyGD.174(3106) A -