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__ ___... _.....�....... ..-�-..........�. .-.-...�.•.•......aa r.�..vr�v�wrvu�v. r r.,u N r wnr,vn ro MnvC,n♦.vmrUnlYl.0 WII A OAI'1 JOAQUIN COUNTY DEVELOPMENT TITLE,CHAFFER 9-1110.3 AND THE STANDARDS^OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSIOR/APPNI� _R c < n C), 2 l� �( CITY lAcc'�'�' ') rJ0- LOT SIZE OWNER'SNAME c/ - ADDRE89 � �� \ Lo'-{ c; -q f PHONE CONTRACTOR �i Vli >4— ADDRESS �j(�/�-.�� LICIf (tLIOgq PHONE SUS CONTRACTOR ADDRESS LIC/ PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION REPAMMDDrMN ❑ DESTRUCTION ❑ (NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PERC TESTIal I I HOW MANY `may, APPfoStlon t INSTALLATION WILL SERVE: RESIDENCE 1.,2r` COMMERCIAL ❑ OTHER❑ NUMBER OF LIVING UNITS: ( NUMBER`OF B OOM8: _ NUMBER OF EMPLOYEES: CHARACTER OF 601E TO A DEPTH OF 3 FEET: G- PFTISUMP SOIL CHARACTER: ^ L W TER TABLE DEPTH SEPTIC TANK/GREASE TRA► 07YPE/MFO rC lelCAPACITY 2LL� CSC,� NO.COMPARTMENTS PKG TREATMENT PLANT❑ DISTANCE TO NEAREST: WELLC1..5 FOUNDATION PROPERTY LINE C LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) I r LFACHN40 LINE No.It LENGTH OF LINES 2 /C -70, DISTANCE TO NEAREST:WELL )(�G/ FOUNDATION��PROPERTY UNE J`• FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL - FOUNDATION PROPERTY LINE MOUNDED t13 WIDTH_LENGTH_DEPTH DISTANCE TO NEAREST:WELL FOUNDATION_PROPERTY UNE SEEPAGE FITS YJ DEPTHB12E _NUMBER _2G DISTANCE TO NEAREST:WELL D Vr FOUNDATION1(el_PROPERTY LINE SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE _ I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL Of DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH 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.' CONTRACTOR'S HIRING OR 1 SUBCONTRACTING SI TORE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COM TION LAWS OF LIFORNIA' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWINO BELOW. /�ry�/ C SIGNED X TITLE: L /!_e-i DATE: PLOT PLAN MAAW TO SCALE)SCALE 'to t 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT•ON INCLUDING COVERED AREAS SUCH AS PATIO8,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. .... .. ....i .. . . .. i i .... .. :... :... . ......... ..:... .. .. .. ......... .. . . 4 .. . . QJ: z ti . 1 J .. .. . .. i. i J .. .. . . ti y. . ..>-..i.... ... .......:...... ......... :. . ... .... .... . ..> .. ..: .... .. ...:. .:. ..'.. ..:......: . ... ................... ..... .... ..:::..: .� :N:: . 9. ::.:::....::.:.:`.... . ..........:..... .. .... `. :• AIS ;. N 01 T. ... .......: . .. .......`.............. ............. W APPLICATION ACCEPTED BY FOR DEPMTM fE L _ ^ AREA DATE: 7A& /4 OR SUMP INSPECTION 2 r,17cw. : (Y .. .9.•N. q 9