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r I",V. OVn �704� .,iV4 C.R'\VI ■7G nYGI'fVC--?lvvl�lvl`F, v� .7�Kvlvcl0 (209) 468.3420 W&WREFUNDAKE PERMIT EXPIRES 1 YEAR FROM DATE ISSWED {Complato in Troikato} APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOtOR INSTALL THE WORT(DESCRIBED. THIS APPLICATION 18 MADE IN COMPUANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STAN S F SAN OAOUIN COUNTY PUBLIC HEALTH SER E8,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSrOR APN+r_ [ter (c `__ -44-�1 TTJI.. _ AA _ CITY s"r LOT SIZE-;? �'k OWNER'S NAME -1119 G� �('Lj.- ...� ADDRESS/-�!c U 'e Jf/E� ' f /�'" C/�- PHONE '16( 7Y S�/ ^ CONTRACTOR , -7 V�'T-. �] �., ADDRESS/c-� F C�I.�.A6>' .{7 � cyek_L" 7 v� PHONE��J,J S 7 SUB CONTRACTOR ADDRESS LIC! PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/AD04TION DUTRUCTION ❑ WO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.1 PERC TESTjvI 1 I NOW MANY o�T�/J} AppNeNfon INSTALLATION WILL SERVE: RESIDENCE�r COMMERCIAL ❑ OTHER 11 NUMBER OF LINO UNITS: NUMlSM OJF�BEIMROOMS: NUMBER OF EMPLOYEES: �y CHARACTER OF SOIL TO A DEPTH OF 3 FEET:J¢AC CI PITISVMP SOIL CHARACTER: GX� WATER TABLE DEPTH SEPTIC TANKIOREASE TRAP ❑TVFEIMFG CAPACITY NO.COMPARTMENTS PKO TREATMENT PLANT ❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE O LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM? r 2 f LEACHINO UNE p NO,S:LENGTH OF LINES."S- Z C G>z R•I'`'L`k C,�>< DISTANCE TO NEAREST:WELL:532 'f FOUNDATION PROPERTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE MOUNDED ©WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LJNE SEEPAGE FITSDEPTH _SIZE S NUMBER��DISTANCE TO NEAREST:WELL!04 r FOUNDATION �6 PROPERTYLINE S (` SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE Cl I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH T1416 PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH ANNER AB TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAW"OF CALIFORNIA.' CONTRACTORS HIRING OR SUS-CONT TING SIGNATURE CERTIF ES THE FOLLOWiNO:'1 CERT AT IN THE PERFORMANCE OF THE 1AMAK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKM '8 73 C PENS LAWNS CALIFORNIA." THE APPUC T UST CALL IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. SIGNED X TITLE: �(Rir DATE: C O• 3 �(7 . PLOT PLAN(DRAW TO SCALE!SCALE "to S, NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERLY. <. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2, OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH A8 PATN]8,DRIVEWAYS,AND WALKS, THE PROPERTY OR ADJOINING PROPERTY, ......_ .._. .� 1` LL� . ;..... : .. i ' ... .. .""` . . .�.. Via... . ... �.. .'.. ..... T.n..�,�. ., .... 3 .. ... .... PAYMENT OCT '31997L.