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APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUN IY I-Un A---I i o..o•��•�.... ..••-•-•••'•- •—"'- ^ '_� <br /> JOAQUIN COUNTY DEVELOPMENTTITLE,CHAPTER 9.1110.3 UNT <br /> AND THE STANDARDS OF SAN JOAQUIN COY PIBUC HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. "� <br /> JOB ADDRESSIOR APNi�V I CrtY/�y-/ LOT 6�� <br /> OWNER'S NAME ADDRESS Al a / 1��'• 1�• �� • NE <br /> CONTRACTORyer E/1 n FV Ht-a _ADDRESS ljj; ! 114/If 1 r IJCi 1336 79 PHONE 7 <br /> SUBCONTRACTOR ADDRESS LICi PHONE <br /> TYPE OF SEPTIC WORN: NEW INSTALLATION RPANUADOITON D DESTIILIOTION❑ <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PEIC TFSTIeI 1 I HOW MANY <br /> AppNwtbn i <br /> INSTALLATION WILL SERVE: RESIDENCE❑ COMMERCIAL OTHER❑ 6p <br /> NMVBEI OF UMNO UMTS:— NLIMBYI OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PTISUMP SOIL CHARACTER: �IWATER TABU DEPTH <br /> 6FIIIC TANN/OREASE TRAP ❑TVPE/MFO CAPACITY Il ��200+1" NO.COMPARTMENTS n <br /> PRO TRGTMENT HNT❑ DISTANCE TO NEAREST: WELL s UBti I C FOUND ON_jro— MPERTY LINE 41_ <br /> ' SIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) / n <br /> LEACHING LURE 4 NO.A LENGTH OF UNEII ��0' DISTANCE TO NEAREST:ViIEUj FOUNDATION PROPERTY UNE (/ <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> ' SEEPAGE NTS ❑DEPTH SIZE_NUMBERe DISTANCE TO NEAREST:WELL NDATION PROPERTY LINE <br /> SkfA .Wry{WIDTH TH�_DEPTH DISTANCE TO NEAREST:WELL F IINOATNIN -�•PflOPERTV LINE <br /> OISFOSAL PONDS LJ WIDTH LENGTH DEPTHH�'�DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE��"�� <br /> Z �'A0I&c Z�[ / 8lx �o`OEEG(J <br /> I HEREBY CERTIFY THAT I HAVE PATTED THIS APPLICATION AND THAT THE WO WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE UVJS IVIG RULES _ <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERT"THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO W WKMAN'S COMPENSATION LAWS OF CALRFORNIA.' CONTRACTOIPS HIRING OR ^ <br /> SUB ONTRACTINGSIGNATURE CERTIFIES THE FOLLOWING: CERRFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO l., <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA' THE AR ANT MUST CALL 24 HOURS IN ADVANCE FORKALL REQUIRED INSPWTIONS. COMPLETE DRAWING <br /> ' BELOW- <br /> SIGNED Xn &L TITLE: DATE: <br /> PLOT RAN(DRAW TO SCALEI SCALE •NI <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. *. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WTU 6 WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. y <br /> . . <br /> .. _. <br /> ....,... <br /> ......a .. <br /> _ PAYMENT <br /> w,c� tr P OCT 2 4 1995 <br /> s : <br /> 11310 : SAN +C;. <br /> Grt i�t PUBLIC NEAP IN FEV1 E4 <br /> (7h bIF AMEN FAL l,itsL7H I�I.lyl7(I <br /> .. <br /> _. ..... <br /> . ..... <br /> 0b <br /> iL <br /> k sclo,ol — <br /> Fr AMFIi <br /> E}' �� FOR 0PARTMENT USE ONLY E� (//����Iyr <br /> APPLICATION ACCEPTED BY G '••� V -�/ '"�-' DATE: v AREA:Y1� <br /> ' TANK,PIT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BY DATE 1L / I /�r' <br /> 1 <br /> ADDITIONAL COMMENTS: I <br /> i�tti al fi. bA <br /> ACCOUNTING ONLY: NDE FAC* <br /> I�� <br />