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APPLICATION IS HEREBY MADE TO THE SAN JOAGUN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. TIME APPLICATION IB MADE IN COMPUANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMEN <br /> T,TITTLE,CHAPTER 0-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> tB ADDRESS'DR APNE f;C uC 5 . 9'-�/,R1n E-4A{�{7 CITY -.< rC /`�^f���1{"1'� _LOT 82E_ <br /> OWNER'S NAME ��.n�a1TL=' w7J ADDRESS �• �" fVJOJC Q w '/ �-`�' VJ{�-,�,ll/LI.'1PIIONF. 3r�n <br /> NTRACTOP <br /> C'3 p-bm Y"r�_ ADDRESS IEP lION V / PRONE <br /> tB CONTRACTOR ADDRESS UCS PHONE <br /> PE OF SEPTC WORK: NRN INSTALLATION ❑ REPA)UADOITION DDITRUCTION ❑ <br /> O SEPTIC SYSTEM PERMITTED IF PJBU^SEWER 18 AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTNI I 1 HOW NIMEY <br /> A plics o S <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL ❑ OTHER ❑ <br /> TIMBER OF UMNO UNITS: NUMBER Gf BEDROOMS: NUMBER OF EMPLOYEES: <br /> HARACTER OF SOIL TO A DEPTH OF 3 FEET:_ PIT/BUMP SOIL CHARACTER: WATER 7ABLE DEPTH_ <br /> 6EPTIC TANKIGIREASE TRAP ❑TYIEAMFO_ CAPACITY NO.COMP/JTTMENTS <br /> F0 TREATMENT PLANT Cl DISTANCE TO NEAREST: WELL__ FOUNDATION PROPEfiTY LINE <br /> UFT STATION❑ SIZE TYPE OF PMP SAND OIL SEPARATOR(ENCLOSED SYSTEMI <br /> LEACHING UNE Cl NO.6 LENGTH OF LINES_ DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> FILTER BED ❑WIDTH LENGTH__DEPTH DIbTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> LNOW 13WIDTH LENGTH--DEFTH OISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY UNE <br /> U <br /> AGE PTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL__FOUNDATION PROPERTY LINE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL__FOUNDATION PROPERTY LINE <br /> SPOSAL PO�NDB ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL__FOUNDATION PROPERTY UI E <br /> HEREBY Ci ERnFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK.WILL BE DONE IN ACCORDANCE W.TH SMA JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CER71"THAT IN THE PERFORMANCE OFTHE WO K FORWHICH <br /> IS PERMIT IS ISSUED.I SHALL,NOT EMPLOY ANY PERSON N SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> =A <br /> -CONT910NATV EFRTIFlES THE FOLLOWING:'I CEIRIFY THAT W 7!IE PERFORMANCE OF THE WORK FOR WHICH THIS PEPMR IS ISSUED, SMALL EMPDY PERSONS SUBJECT TO <br /> R(MpN'8 O NSgTO OF CMIFOIOIl1.' THE APPICANT MUST GAIL 28 1101N IM ADVANCE FOR ALL REOURFD INSPBCTONS. COMPETE ORAWINO BEIDW. <br /> �NED X ` TITLE: ��"+-TY YJLIZSCTi'W DATE: d - 2�t�S S <br /> ROT PAN(DRAW TO SCALER SCALE 'ie <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. ♦. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DKIENSONEO OUTLINER AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE POPERTY OR ADJOINING PROPERTY. f <br /> lG•'.l�c� "5�...k4.a121Ai.�1 . . . . . '�C <br /> PAY <br /> REC.EhfEA .. .. . ... .. <br /> APR21995. . . <br /> ........ . . . <br /> SAN,IOA000N cOtr,l 1 <br /> PUBLIC HEALTH SEh Vl <br /> . . ... ENVIROCES <br /> NMENT <br /> ... . . . . . . . . . . - AL HEALTH o+VISIor,. <br /> . A. .. ... .. �� ARTMENT USE ONLY <br /> (CATION ACCEPTPO BY of d-/ C�QQ C. ! DATE: AREA <br /> I <br /> �K.PIT OR BUMP INSPECTION SV DATE l l FINAL INSPECTION BY DATE 14CC I.C�S— <br />