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I 3A OAQUIN COUNTY PUBLIC HEALTH SERVICES tENVfRONMENTTAL HEALTH DIVISION P.O, BOX 388 304 EAST WEBERMENUEI STOCMR CA 95201-988 12091 US-3420 »08•REFUNDARLE PERAOT EXPIRES 1 YFAR FROM DATE ISSUED FFF APPLICATION W HERBY MADE TO THE BAN JOAOUIN COUNTY FOR A PEFMIT TO CONSTRUCT AND/OR MSfALL THE WOW DESCMSED. TM APFIJCATON t6 MIAM M COMPlW10E WITH WX )OAam OOUNTY DEYELOftWff TMX.CHAPTER 8-11 10.3 AND E�STTA�rNDARDB of78�AW ICB(UMAOUCOMITY OnUt HEALTH SERVE� ENV_tRO/MMENTAL HEALTH OMMM. IO8 AOFlE OSSIOR API+' :3 /CJ RM MM NAME C C UPHONE 4 7.j ,,.1�.P� .l�r ADDRESS '�f Lo �!.-• f 'A ��r /• ✓�rTI S J �tG+ ,AdB�GJ C- /rL�C�f7•!t / s�� LICJ 7 C F,tOHE ] v Oft ADOFiE88 tlC. pFp j 'YPE OF$SIM WCRR: NEW TNBTALIATION ROPARVADWTIOM Denvic mm(] 1 r 40 G fM SVETf.M PUMARIED W PWJC SEWER ISA ARASIE VATHRt 200 FEET Of MKLSaGJ POIC TESTL•)L 1 NOW MANY-- APOSweon+ MCTAtLATNN WRL 6EiIVE; RESIDENCE VCOMML rm 13 0THER 13 OF UVINO UNTf: / NUNBBR OF S 3NUVMM OF 6WPLOYETD: OF aoLl TL11 A DEPTH of J FEET Mn FTTA"A P SOX CCHARACTER;ryTysf7pT5r oar.-WATER TABLE DEPTH /O I•>� �] -�KAdRE/16E,RAP fJ -elmll- CAPA�CTTY /—lO'71Do NT1 O.COM?AR �19fi8_. 17( ILO TIIFAT'IAENT PLANT❑ MTARCE TO NEAREST: WELL �dO i FOUNDATION_ PROPERTY LINE UFT"ATM 11 Sm TYPE OF PUMP BAND OIL SEPARATOR M# OSED S"WM r[A...UNE �Ho.•uoMIGnT oP ueEe 3--5/0` /.%t1^a-- Ot87ANC£TO HFIITIEST:WBd,� .FOIiNpAT'lON �s ' T'ROPetrr LsaE �� LTLR am ❑wO'TH LENGTH DEPTH DISTANCE TO NEAREST:WEtJ—FDUNDATON - PROPERTY LINE Oimm 13 WIDTH LENGTH DEPTH DISTANCE To NEAREST:WEU. FOUNDATION PRDPERTY UK DLrrTI i sty s. r"AmPm )a �� MIMBFR 3 DISTANCE TOIIEAREST:wELL/—ca'_FOUNDATION_�o , PROPERTY UNE O / AWePs CI%mm LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTYUNE SPOW.PONOf ❑WIDTH LENGTH DEPTH DISTANCE TO HEART.WELL FOUNDATION PRDPEiTT'V LINE e OWY CUMN THAT I HAVE PREPARE/THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAW JOAQUW COUNTY Ofq)mANCEB AND STATE LAWS,AND RUL£S IDRESULATIONBOFTHESANJOAOUBMCOUNTY.HOMEOWNEAOR AOERMSIGNATURECOUTMBTHEFOLLOVMINO:lCB(TII•YTHATINTHEP JANCEOFTiffWORTFORWHICH NO PERMIT 19 ISSUED.1 SHALL NOT EMPLOY ANY PERSON a SUCH A AO TO BECOME SUBJECT TO WOgLMAN'Y COMPE.NAATON LAWS OF CAUFDRtM.- CONTRACTOR'S HIIVNG on rfx 1CHtTiFY NTHE PERF0f MANCEOFTHE WORK FGR WICH THtB PHG.IIT IS •I SHALL EMPLOY PEIWGNS SUBJECT TO All •� HOURS IM ADVANCE FOR ALLLICMWMD OIOFWTKM& COMPLETE DRAWRM BROW.TITLE: DATE_ y~�7 7J 171.OT PLAN tDRAW TO SCALE!SCALE -Iv 1 NAMES OF STRUTS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. t.LOCATM OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED F OUTUfE OF THE.PROPERTY,WITH DOJENSIONB AND NORTH OIP4CTI ML IDWASSION OF SEWAGE UISP'OSM.SYSTEL4& O"ADMONW OUTLIES AND LOCATWN OF ALL EOOBTINO AND PROPOSED STR ICTURES, S- LOCATION OF WB,L.S VATM RADRMS OF ONE HUNDRED FIFTY FT,ON RJCLUDINO COVERED AREAS SUCH AS Pam,DRIVEWAYS,MMD WALKS. 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