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SAN JDAIMIN-COUNTY PUBLIC-IfEAL78 SERVICES <br /> "—,A <br /> P -—, <br /> ENO "IENTAL HEALTH DIVIS CAD'I — <br /> —TI"'T' Pu", tY I-B X SK PD� <br /> j1p, 0' ERAVENUE,S1 <br /> (2091480.3420 <br /> "��lmlf..PERWT Exq4f YEAR FROM DATE Issu§F i"CIAL <br /> Q ni <br /> in Tripf" <br /> APPLICATION 15 F4kiFY AAbiF-T6 THE SAN JOA.UIN COUNTY FOR A PERMIT Ta comgmucT ANDion iNsvALLTHIF WORK DESCRIBED.THIS APPLICATION 18 MADE IN I <br /> COMPLIANCE WITH S)TN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS or SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH Dimm". <br /> JOB ADDFIESMR APHOCITY LOT SIZE <br /> OWNER'S NAME -Yc k <br /> ADDRESS PHONE 9 <br /> CONTRACTOR S-2..'i- <br /> ADDRESS/ <br /> SUS CONTRACTOR ADDRIERS —LFC# PHONE <br /> TYPE OF SEPTICWORK: NEW INSTALLATION An REPAIR?ADINTION DESTRUCTION <br /> M SEPTIC SYSTEM PERMITIED IF PUBUC SEWER IS AVAILABLE WITHIN 200 FEET OF SUILUING.I PE RC TEsTwi E I NOW MARY <br /> INSTALLATION WILL BERVT: RESIDENCE 0 COMMERCIAL 99 OTHER 0 <br /> NUMBER OF LIVING UMTS; NUMBER OF BEDROOMS:_NUMBER or Emmov!rw s. <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: FfTISUK4PMSL CHARACTER: -A"IN--j �AfER'TABUEDEPTH '2" <br /> cAPA." <br /> SEPTIC TANKOME"t TRAP If L-11—NO.COMPARTMENTS <br /> PKO TREATMENT PLANT 0 INSTANCE TO NEAREST: WELL FOUNDATION_ PROPERTY LINE <br /> LIFT STATION 0 SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LtAc"Na UNE 91 NO.&LENOTH Or LINER <br /> DISTANCE TO NEAREST!WELL FOUNDATION PROPERTY UNE <br /> FILTER RED 0 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION. PROPERTY LINE <br /> MOUNDED 0 WIDTH r LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYLINE <br /> SEEPAGE PITS 0 DEPTH .1E MREn DISTANCE TO NEAREST:WELL_FOUNDATION C-0 PROPERTY LINE <br /> BUMPS [3 WIDTH LENGTH DEPTH DISTANCE To NEAREST:WELL FOUNDATION PROPERTY LINE <br /> DISPOSAL PONDS 11 WIDTH LENGTH DEPT" DISTANCE TO NEAREST:WELL FOUNDATION rnommY UNE_ <br /> I HEIREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATION:OFTHF SAH JOAQ IN COUNTY.HOMEOWNER OR LICENSED AGENT'S SIGNATURE CERTIFIER THE FOLLOWING;'I CERTIFY"THAT MINE PERFORMANCE OF THE WORK FORWHICH <br /> THISPEMITISIS LED,I SHALL NOT EMPLOY ANY PERBOR IN MUCH A MANNER AS To BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.-CONTRACTOR'S HIRING OR <br /> SUM-C"NTRACTING SIGNATURE CERTIFIES THE FOLLOVANO:'I CERTIFY THAT IN THE rEWORMANCE or THE WORK MR WHICH THIS PERMIT 19 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED tNSPECT1ONO. COMPLETE DRAWING BELOW. <br /> BIGUM X e�i OATEi 7 <br /> PLOT PLAN DRAW TO SCALE)SCALE <br /> Ia - <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR ROUNDING THE PROPERTY. 4.LOCATION OF HOUSE REWAOE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF THE PODPERTY,WITH DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SEWAof DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S.LOCATION OF WELLSA"HIN RADIUS OF ONE HUNDRED FIFTY Fr.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> . . ............ ... <br /> ..... ... . <br /> .............. <br /> .................... <br /> ........... <br /> ............. <br /> ... ....... <br /> ... .. ...... <br /> ... ..... ....... <br /> ............... ...... <br /> ............ .... ................ .......... <br /> . ... .. .... .... <br /> m <br /> 7N. <br /> ...... .... . ...... <br /> .. ..... ......? <br /> ............... . ....... <br /> .......... <br /> .................. <br /> ... .......... <br /> ............ <br /> iov, <br /> ............. <br /> 04, em <br /> .... ...... ....... <br /> L Ij <br /> ............ <br /> o <br /> .......... r <br /> m .. .... ...... ............ <br /> .......... ....... <br /> ...................... <br /> ..... .............. ..... ...... ... .................. <br /> .... . ........ <br /> �Vt ............ <br /> ................ <br /> ....... ...... <br /> ............ ............ <br /> . ...................... ................. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By. DATE: -7, AREA: <br /> TANK.PIT OR SUMP INSPECTION BYT I FINAL INSPECTION BY 41 V--- ATI, <br /> AbMIDNALCOMMENT& N) A-Q�A Iz. <br /> ACCOUNNNO <br /> ONLY: AI.! r-, <br /> PT CODE FEE INFO AMOUNT RFfWLTFD CIIECKI ASH RECEIVED Rv 'DATE_ I-SR f PERMIT NUMBER INVOICE) <br /> d <br /> Pub Health Sow.-Enviro.174 <br /> W") <br /> 3 <br /> jo. <br />