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imomplats Is TTipWt.) ---r — <br /> AIV(CATION IS HEREBY MADE TO YHE BAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBED.,THIS} PLIANCE WITH BAN <br /> JOAUUN COUNTY DEVELOPMENT TITLE,CHAPTER 9.`1110,$AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONME _- <br /> iJOB ADORESS/OR AP/NY 1�LJ ��'.l�I� L.� ��G/G I, c-Cr M,p` CRY -4 WLILT SIZE <br /> OWNER'S NAME Lkarl.IUS 1451141+Aup ADDRESSdL�ro_ PHONE OAL—w Log <br /> CONTRACTOR 1/-I� ADDRESS <br /> i �,u, SL+ti[ LICE FMONE S� <br /> SUB COWRACTOR__n!N I V—e- CL,(11 ef- ADDRESS Q n RSOY (05"0 UC/,yLT',� .�'1J-lI mow�3.5--z2z3 <br /> �y� <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION Eo REPIAVADTNNON ❑ DEBTRUGTNIN❑ <br /> i <br /> (NO SEPTIC SYSTEM PERMITTED IF PUBLIC.SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING) PIPC TDTTBI 1 I NOW MANY <br /> Appy .P <br /> INSTALLATION WRLLBERVE: REBIDEWEp/COMMERCIAL❑ OTHER❑ <br /> NUMBER OF U"W UNITS: NUMIB61 OF BEDROOMS: J NUMBER OF WPLOYEES: 1 <br /> CHARACTER OF SOIL TOA DEPTH OFF33 FFSET: _<QB q PIT/SUMP SOIL CHARACTER: �f:id WAIERTABLE DEPIII <br /> SEPTIC TANNIGREASE TRAP l TYPEWFp 00*L LS CAPACITY I,a.'A(1 NO.COMPARTMENTS �. <br /> ROD TREATMENT PLANT❑ DSTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> i LIFT STATION❑RING. <br /> TYPE OF PUMP SAND OIL SEPARATOR IENCLOSED SYSTEM1 <br /> LEACH"ONE to NO.6 LENGTH OF LINE 6�_ 171 DISTANCETO NEARI!Bi:WELL1617#' FOUNDATION rte+ PNOPERTI'UNE ^�/ V <br /> FILTER BED ❑WIDTH LENGTH--DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PIOPERIY ONE <br /> MOUND® ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> i <br /> SEEPAGE NTS 0DEPTH _SQE NUMBER DISTANCE TO NEAREST:WELL—FOUNOATION PROPERTY LINE <br /> 'pS-- <br /> SUMPS •MDTH_� _LENGTHi4DEPTHLTi_OISTANCETONEAREST:WELL LW' FOUNDATION Inn FOPEMNE aS-r w <br /> DISPOSAL PONOS ❑WIDTH LENGTN DEPTH OWANCE TO NEAREST:WELL__-FOUNDATION PROPERTY UNE <br /> i I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN MASON!COUNTY ORDINANCES AND STATE LAM,/WD RULER <br /> AND REGULATIONS OFTHE BAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT <br /> 'S SIGNATURE CERTIFIES THE FOLLOWING: CERTIFYTHAT IN THE PERFORMANCE OF THE WORILFOR WHICH <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER,AG TO BECOME SUBJECT TO WORIMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONT ACTOR'S HIRING OR <br /> SUS-CONIRACTINO SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECTTO <br /> WORKMAN'S COMPENSATION LAWS OF CAUFOANUU' THE APPLICANT MUST CALL k NOW IN ADVANCE FOCI ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. pi SIGNED X ` .t!4- TITIf�: eA 1 p r <br /> JwMG� DATE: L� �/^ �cl <br /> i ROT PLAN IDRAW TO SCALE)SCARF. 'CO <br /> 7. NAMES OF STREETS OR ROADS NEAREST TO ON BOUNCING THE PROPERTY, A. LOCATION OF HOUSE SEWAGE DISPOSAL SVSIEM OR PROPOSED <br /> I. OUTLINE OF THE PROPERTY,WITH DIMENSIONG AND NORTH DIRECTION. EXPANSION OF SEWAGE DIa'OSAL SWTEMS. <br /> 3. DIMENGIONED OUTLINES AND LOCATION OF ALL EOSTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON 1, <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS, THE WOPEGTV ORADJOINING PROPERTY. <br /> \� <br /> : . . . . .... . <br /> .. .. , <br /> i <br /> l�s? <br /> Q ..... . . . °' <br /> :mss <br /> 1 <br /> . . . ..... .. ......... .. .. . ............ . . . . . . ....,. ..„ . . <br /> . ..-..... . . . . :...... .. . . .... .. . ...... . . <br /> e <br /> i <br /> .. _ <br /> � <br /> .. ....... ... .. . <br /> ix .. IJl.. .,.:..... j ... <br /> r -L .... <br /> mn. <br /> 1 „ . . . . . . <br /> w <br /> i FOR DEPARTMENT USE ONLY - - - <br /> APRICATION ACCEPTED By DATE: o <br /> TANK,PIT OR SUMP INSPECTION BY GATE ! I FINAL INSPECTION B GATE%I/ 1 <br />