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................... . --.... ... .. JDAWIN COUNTY DEVELOPMENT TRIS.CHAPTER 9-111 .3 AND TXE STAND,&DB OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. OR AppR66/OR APNI •�IR,,.f� , CRY LOTSIZE ER'S NAMEP ADDRESS ( 12 Sa SwLouaz",D 74 •Q 7.Q(` ONTRACTOR C eH � 50 ADDRESS UC# 3f)'/�4 R10NE 'US CONTRACTOR l000l ADDRESS UCI PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION IT RVAIRAmmeom ❑ DESTRUCTION❑ _ SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 100 FEET OF BUILDING) PERM TESTI.1 I 1 NOW MANY APMl.tlon s c INSTALLATION WILL SEINE: RESIDENCE R COMMERCIAL 13 OTHER ❑ UMBOR OF LIVING TSi 'HARAC ER OF SOIL TIO A DEPTH OF 3 FNUMBER OF BEDROOMS! TISUMP NUMBERWit H RAS ROY WATER TABLE DEPTH D! 5^G✓0 SEPTIC TANRGREME TRAP ❑TYPEINIM CAPACITY NO,COMPARTMENTS PRO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE UFT STATION❑ SIZE TYPE OF PUMP BAND OIL SEPARATOR(ENCLOSED SYSTEM] REACMNG UNE O NO.I LENGTH OF LINES DISTANCE TO NEAREST.WELL FOUNDATION PROPERTY UNE FILTER SED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION /APRO�P/E■�R��TrYY LINE 13 WIDTH H LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PE 'PiKEPnRIKlg I6TFAGE RTS ❑DEPTH 817E NUMBER DISTANCE TO NEAREST:WEUI POUNOATION R Wj!^ERLVUNfj RNMM ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION SPOSAL PONOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION_ _ WHEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUN�t+w�nc{q�nA D TE'GWe,ARp RVIEe AND RAULATIONS OFTHEBAN JOAQ IN COUNTY.HOME OWNERORUCENSED AGENT'S SIGNATURE CERTIFIES THE MULOWINO:'I CERTIFYTHATINTl1E I1FjLP,�]qM�1E',oy� NO THIS PERMIT IB ISSUED,1 WALL NOT EMPLOY ANY PERSON IN SUCH A MANNER A8 TO BECOME SUBJECT TO WOWMAN'B COMPENBATIO/P`XWbA klP,C1�1R?WLAn LCP`r1�Retf�'ItiiAi�T 00 ,•.• WUB{ONTMCTINO SIGNATURE CERTIFIES THE POLLOVANG:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORT MR WHICH THIS PERMIT IS ISSUED.I SHALL EMPLOY N 'V11, OWMAN-8 COMPENS&THKLAW8 OF CALIFORNIA: THE APPLICANT MUST CALL U HORS IN ADVANCE FOR ALL REQUIRED INSPICTONS. COMPETE DRAWING BELOW. �P� r, dr �� 11 -�sA SIGNER% kl�� • TRIS: DATE �B PLOT RAN(DRAW TO SCALE)SCALE 'RP . NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 3. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. - EXPANSION OF SEWAGE DISPOSAL SYSTEMS. IdDIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON IRCLUDING COVERED AREAE SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. [ C o �J I V , - — — �— — �f �. W r-` + I" wi. ^I N• -�),ti�� ti:_fir I I `-`_ 4�7F 'h Ll IX C `; c• � � I i `�� _ F� I i ��— •r;:Y SAI:. I i �1 �• .f, I I � � I• � IIIIUUUUB��'''''' FOR DEPARTMENT USE ONLY q �(��y�///,�• (CATION ACCEPTED BY DATE: /D AREA: 1p/v 7/ /L_/ UNK,PR OR SUMP INSPECTION BY DATE I I FINAL INSPECTION RY�� I i KA A. P iu-) n Tc