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ION IS HEREBY MADE TO THE SAN JOAGUM COUNT R A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOR(OESCF"E` THIS APPLICATION IS MAUt IN i,�rwrur.m.c••'•"..^•• 1 COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.,..,j THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH 81 8,ENVIRONMENTAL HEALTH DIVISION. CG'S /,7�l1.� Cm /l"�?f/� S LOT StZE�� ODRESS/OR APNA 1 t! ., iIys �' 7 ADDRESS G 7 �L•S /O// �f //� PHONE /J^ •.a NER'S NAMEY. v __ �l�• /rte�/ L% PHONE 7 .CJ ll��' 1"^✓'�`/ j INTRACTOR .��✓G�..f/� / ADDRESS /"7/"7,? . ucvPHONE IS CONTRACTOR ADDRESS_ �— 'PE OF SEPTIC WORK. NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION ❑ tNgtC rI;ETI+)1 1 NDN►MANY --y- 0 SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING I '- b - s)� // APPNoatlon I G T C5 ISTALLATION WILL SERVE' RESIDENCE ❑ COMMERCIAL ❑ OTHER ❑ UNB91 OF LMNO UNITS NUMBER OF BEDROOMS NUMBER OF EMPLOYEES H ARACTER OF SOIL TO A DEPTH OF 3 FEET: WT/SUMP SOIL CHARACTER: WATER TABLE DEPTH E/TIC TANK/QRFJL[E TRAP ❑TYPEIMFG CAPACITY NO.COMPARTMENTS KO TREATMENT PLANT ❑ DISTANCE TO NEAltESL WELL FOUNDATION PROPERTY LINE _ UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM/ EACHSNO UNE ❑ NO.•LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE AT91 BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE .10 UNDED ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE :EEPAOE HTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE ;UMPS ❑WIDTH LENGTH DEPTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE 316P0[Al PONDS ❑WIDTH IENOTH I HEREBY CERTIFY THAT I HAVE PREPARED TM13 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNT/ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUINCOUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK TOR'FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER IA.' CONTRACTOR'S HIRING OR AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CA SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING' 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 13 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WOIKMAN'6 COM NSATION LAWS OF CALIFORNIA.' THE MUST MUST CALL 2A HOURS IN ADVANCE FOR ALL REQUIRED INS,P{ECTION$. COMPLETE DRAWINO/BELOW _ _ 8-+-v� TITLE: C/�J,/ // DATE: SIGNED X L1 �VYy PLOT PLAN(DRAW TO SCALE)SCALE 'to 4, ^.E DISPOSAL SYSTEM OR PROPOSED 1 NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 00 ,q IAL SY8TEM8. 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTIft- C'� 'US OF ONE HUNDRED FIFTY FT.ON 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTINO AN ED STRUCTUF40 ' •TY INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEV�AX04 �' •/ ,Kip ��, •y�S O ��g'f /i�` %• fez �c,,o O SnNL w£u 'f OJ�N (j4`.2�Rto`ERIY LINE..... '"A R �� P ;......n<. �'�� MEN�P NEP ._� �+� e` i �� << cam. •J•_ NCW PRO-EFTV UNE...._... i cl �N�I HO•S �° ♦ 0.,C PROBER V(] MAP AP /, J�`•yy `6 •. w� 1 :. C\y \� IN 8•e�r� � � _.... C1USnNC SCcr._ 1•Nk i 207 15 PEMAINDER / _ ..... •� , •.-,R•e=' - - S.F I � ......... 2.25 ACR—S _.... . NEWPRS:- TM UN' 4L `L y PAR�EI NO. 1 O 1 a C` •.i•i E •sc r-tZtµ/,INDER 0 to 0, x0et •Z �.�/ i '1 ?. S DCR=$ — _�� Al _,�c` S r fr Jg. .ScE DETAIL •A. '21/� I PAR` No. - �Y t� y�"� 6� �0 20 O- AJ E5 PAROF ! H SIM( �= NC- .00. I/.xcnP•vrt1 ;/ _ f _�-�—� �—� _ I o I. � n 0 SCALL 1' 30' I C PAR:� ��• "' n. Cc NCR � yr�a I Q b ppYME�T 0ATE A/R1EA: I