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IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 18 AVAILABLE WITHIN 20O FEET OF BUILDING.I MIRO TESTyI I )HOW MANY APNlostlan a INSTALLATION WILL RFAVE: RESIDENCE❑ COMMA OTHER ❑ NW86 OF LIVING UNITS:__ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: A CHARACTER OF SOIL TO A DEPTH OIFF�23I FEET:A-e�nbs / PIT/SUMP SOIL CHARACTER:_ I IP. WATER TABLE DEPTH SEPTIC TANK/OREASE TRAP ` ! Gy TYPE/MFG Chi j Nl� 'fin` CAPACITY (�pQ ND.COMPARTMENTS .. _ ('1 Q 4fl; WO TREATMENT PANT❑ DISTANCE TO HEAAEST: WELL / h ` j FOUNDATION 19>0 / PROPERTY LINE by UFT STATION❑ SIZE TYPE OF PUMP SAND OIL SFP.CRATOR(ENCLOSED SYSTEM) 1 LEACHING LINE ® NO.S LENGTH OF UNE$ c -:_1 Gip I DISTANCE TO NEAREST:WELL �A'�I FOUNDATION 1 1.1C= PROPERTY LINE �I r� FlITDI BW ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNw MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUR O SEEPAGE RTS ❑DEPTH SIZE NUMBER DISTANCE TO NEAREST:WELL FOUNIPE RTY U SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOVNPROPERTY UNE A DISPOSAL PONTOS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE lAWB,AND RULES v`'• AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT D THE PERFORMANCE OF THE WORK FOR VMICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTMCTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO .� WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. r SIGNED%_ TITLE: r ,,C42 Qj A-' .. n DATE: PLOT PAN IORAW TO SCALE)SCALE 'to 1. NAMES OF STREET$OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. A. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OMUNE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. G. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERT'OR ADJOINING PROPERTY. �p C{ fucla sm ` 5 _�.2 � rlp0 CI HEALTy .k; rjv�` NME�VTgL REALE �eEC 49 Y. Stb* _ e i... .... ;. ...:..... . t MR DEPMTMENT WE ONLY ], - APPLICATIONACCEPTEDBV \. DATE: A AREA- TANK,PT OR SUMP INSPECTION(((B��Y�\\ EE�� DATE / / FINAL INSPECTION BCY1� !� ATE ADDITIONAL COMMENTS: T .-.Y11>s 11 rc IN 2 c/c.li�/_ a>°��'v�i,odo >•ecJ �.2��,l. „tie 6'c� ACCOUNTING ONLY: AID# FAC# PE CODE FE FO AMOUNT REMITTEDHEC /CASH RECEIVED BY DATE SR/ IT NUMBERINVOICE# '�'0, .