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SAN JOAOUIN COUNTY PU13LIC NIALT4 SERVICES <br /> ENVIRONMENTAL HEALTH DIVISIO , MIF I_�:j's•1'f'Y`.Fi3u1.I::FT" `'` $ VIC83 <br /> �$ <br /> P.O.80X 388.304 EAST OSIWEBER 4 BV d20 �,��Ql.� r`t:.Lel:.�:•'':: . <br /> 7 pELVil 1, <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED�� � ' <br /> (ComplEn M TTIpIketil <br /> APPLICATION IS HEPEBY MADE TO THE SAN JOAQUIN COl1MY FOR A PETW IT TO CONSTIILICT ANDJOR WSW4!'TFE WOIV DESCRIED, THIS APPLICATION 18 MADE IN COMPLIANCE WET'A MN <br /> N. <br /> JOS ADDREC•S AR ApN►�/7�g PNIVNT TITLE. AVEOI 9-1110.3 AND THE YT�AR`DB�SAN JOA C `PLY PVSUCCITY � ��NNENTAL HEALTH OI��OT SIZEA_" <br /> CIA/ER'S NM1 •/' MDRESR PHONE, v mak' T <br /> CONTRACTOR��iCBZ AEIOIESS I�l C-C�a�G,�` V•U� — LIC/ ATONE�b3 5343 <br /> SUBCONTRACTOR wDORESa 1101 PIDNE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATIONR®AIRIADd POM❑ DFATRUCTION 13 <br /> INO SEPTIC SYSTEM PEIMEETED PF FVSUC SEWER tSAVAILABLE WITHIN]00 FEET OF RIRLOINO.) iHSIC T-Tld(1 HOW-ANY <br /> �/) APPlleitlen I_ <br /> INSTALLATION WILL SIVE: REaIDENCE❑ COMMERCI�IL Q OTHER❑ <br /> NUMBER OF U"m UNITS. RUNMEN OF SmROOMS: NUMSEU OF E KOYFFA: I Z <br /> CII OF EOR.TO A DEPIN OF]FEETJ �?-�_AT/SUMP ROIL CHAMCTEN(- WATER T.MIF DEPTH <br /> C TANI�NIKAS[TRAP ❑T'-K CAPACITY _No.co LIPARTMFNTS r'1. <br /> TEAEIT PLMT❑ OWYANCE TO MEAIIFJtT: WELL AJ FOUNDATION 13 , <br /> 'ICOR'LINE <br /> LIFT STATION❑ 812E TYPE�F PUMP SAND OIL EEPARAton IENCLDSED SYSTEMI <br /> LEACHING UNE ❑ NO.S LENGTH OF LINES_ DISTANCE TO NEAREST:WELL —FOUNDA1gN PROPERTY UNE <br /> TILTOL SFD ❑WIDTH tEN07N_ DEPTH DISTANCE TO NEAREST;WELLFOUNDAVON PROPER Y UNE <br /> MOUNDED �I❑��W DTH LENGTH_ DEPTH DISTANCE TO NEARER:WELL FOUNDATION PROPERTY UNE <br /> SEEPAGE RTS EPTH 7� Siff NUMBER DIETAHCE TO NEAFJEST:WELL FOUP.OATION�_PROPERTY UNE <br /> ampsWIOTM LENGTH T DEPTN DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONDS [3WIDTH LENGTH DEPTH OISTANCE TO NEAREST,WELL FOUNDATION Pm0KRTY LINE <br /> I HEESY CERTIFY THAT I HAVE THIS APPLICATION AND THAT TSL WILL BE DONE W ACCORDANCE VAIN SAN JOAQUIN COUNTY ORDINANCES AND STATE LAM,AND RULES <br /> ANDREGUTATION FT JO NJ .NOMEOWNERORLIC O ENT-SMONATUTECEPTIFlESTHE FOILOWMIO:'ICE1RfY THAT SITHET+EPEOIMAEICE OT 7Nl NOIEC 8011 WISCH <br /> at D, 1N T EIA O V PERSON W SUCH A NNt AS TO BECOME SUAIECT TO WOPE(MAN•S CJMR:NSAT$oN LAWS OF CAUFORNIA, COMRACTO/I'S NSRSq 011 <br /> {O ATU CERTIFI THE LLI1W1 L !E.$BFOHMANCE OF THE WORN FOR WHICH TTBS PERMIT I ISSUED,I SHALL EMPLOY PERSONS RUWFICT TO <br /> NCMAN'S C Pt T AN MUST ALL 74 HOURS IN ADVANCE POR ALL REG ItNPECl10Mi.COMPLETE DRAWING BELOW. <br /> SIO A TOLE:�Q bATE:, <br /> ROT PLAN(DRAW TO SCALE;SCALE _ _ <br /> 1.NAMES OF STREETS O�VATNI <br /> R BOUNDING THE PLIDPERfY. t.tOCA71ON OF HOUSE SEWAGE DISPOSAL--FM ON PROPOSED <br /> 7.OURINE OF THE PROS AND NORTH 01RECTION. EIPANVON OF SEWADE DBPOSAL SYSTEMS. ��- <br /> ]. OWNSIONED OUTLINES AND LOCATION Of ALL EXISTING AND POPOBEV ST RIICTUYER, S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. .`.;;:1 THEPRCPERTYORADJ04MNGPR]PEIRY- <br /> .moi lJ .' s •:8-- <br /> 7. <br /> :..NOv <br /> V <br /> • u <br /> A h <br /> 51.._... .. ..:. J,aZ ... <br /> <....:............... ....-.a .. ... .. :. ... .. 4��� <br /> �u .` � . <br /> �--- . 99 <br /> o - - <br /> FOR DEPARTMENT GIE ONLY <br /> APPLICATION ACCEPTED BY_ fit,F J •,6 DATE: <br /> �R INSPCT'AlI BV DATE !L I iINAL 019PEC TIDN by <br /> ATIORp MEN 15: L u' 1 <br /> ACCDUNIN Dray: AIOF rncF <br /> PE CODE FEE INFO AMOUNT-'Aj CLEC CAE. 11ECOVED sY GATE SR I P1iSAT RU.ISEI INVOI C[/ <br /> I S \ 5 38 <br /> Pub.Haalth Sam-Enviro.174 9109 �i <br />