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Application is hereby made to the ban doaqurn wu,.z '�' mF •- -••--•--- - "".- --- - <br /> is made in compliance with Sen Joaquin County Development Title, Chapter 9-1110.3 and the standards of Sen Joaquin County Public Health <br /> Services, Environmental Health Division. ��Jj C�(Y�( <br /> Job Address/or PNN JJ__ ''II << ,�7*Gran(t�y,""'.�"�pc t e c <br /> Owner's Name ,JJ wh Address %112 UO S9CY►9Uf/1-Qf 40 ` T' • LQ�1 Phone33 ./F7.0� <br /> ' Contractor_t�d •� Address Lich Phone <br /> Sub Contractor Address Lich Phone <br /> ' TYPE OF SEPTIC WORK: NEW INSTALLATION REPAIBlADDITION 11 DESTRUCTION I) PERC TESTis)I I New manl <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE N THIN 200 FEET OF BUILDING.) Lard Use Application <br /> Installation will serve: Residence_ Commercial Other_ <br /> ' Number of living unita:_ Number of bedroom: Nurbor of employees: ID <br /> Character of soft to a depth of 3 feet: c Il)I) Pit/sump Soil character; Water Table Dopth� <br /> SEPTIC TANKIOREANE TRAP 17 Type/Mfg A�W0 6T Capacity No. Conpertmanta <br /> ' PKO TREATMENT PLANT [ I Distance to nearest: Well G Foundation Property Line <br /> LIFT STATION p Size_ Type of Punp sand Oil Separator (enclosed system) <br /> IEACHINO LINE No. 8 length of tines�I-• -X <br /> OD /Distance to Nearest: Wait- V^ Foundation �.. ( Property Line 1491!7 r <br /> FILTER BED ❑ Width_ Length_ Depth " IN Well Foundation Property Line <br /> MOUNDED I) Width_ Length_ Depth " IN Well Foundation Property Line <br /> ' SEEPAGE PITS [I Depth_ Size — Number " " Well Fourndatior Property Line <br /> [1 <br /> SUMPS Width_ Length Depth " " Well Foundation Property Line <br /> DISPOSAL PONDS [I Width_ Length_ Depth " Well Foundation Property Line <br /> ' I hereby certify that I have prepared this application end that the work wi ti be done in accordance with San Joaquin County Ordinances <br /> and State Laws, and Rules and Reputations of the San Joaquin County. Home owner or licensed agent's signature certifies the following <br /> • "1 certify that in the performance of the work for which this permit is issued, i shall not employ any person in such a roamer as <br /> ' to became subject to workman's coipensation laws of California." Contractor's hiring or sub-contracting signature certifies the <br /> following: "I certify that in the performance of the work for which this permit is issued, I shalt employ persons subject to workman's <br /> compensation laws of California." <br /> The applicant m II 24 home In advance for all required Inspections. Complete drawing below. Q [� <br /> ' Signed X ; ��'� _ Title: D�t.VVLJif• Date: VO ° —q <br /> PLOT PLAN (Draw to Scale) Scale " to <br /> 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> ' 2. outline ofthe property, with dimensions and North direction. proposed expansion of sewage disposal system, <br /> 3. Dimensioned outlines and location of all existing and proposed 5. Location of wells within radius of 150 ft. or <br /> structures, including covered areas such as patios, driveways, the property or adjoining property. <br /> and Wet s. —,-•-- <br /> ' <br /> 1 C <br /> 01j p1g � <br /> P yM N! 11 <br /> L rte. <br /> ' U G 18 199151 <br /> ER <br /> /;GE <br /> N VI �N IENT ' T <br /> FOR DEPARTMENT USE OMIY <br /> ' Application Accepted by Date: / S Area: <br /> lank, Pit or Sump Inspection by Date / / Final Inspection Date /o/ /01 <br /> Additional Comments: "�•`'-ems '`"- "-v <br /> sof ' <br /> _o s <br /> rr� I <br />