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RUN-Ntf URVABLL PtRM1T tAFIRE3 I YEAR FROM DATE ISSUED <br /> (Cemykle M TrydkelS) <br /> APPLICATION BB HEREBY MADE TO THE BAN JOAQUIN COUNTY OT 10 CONSTRUCT MGM INSIALL 111E WDK OFSfmal y/ Y<IOAPON R MACE M COMPLIANCE WAIL SAN <br /> "AWN COUNTY DEVELOPMENT TITLE.CHAPTER ER 9.11 .�A7V/1 /A/yD/A7RT) I'M JOAOUIN COU Y_-AM HEALTH BE yW* NORMAL HEALTH DIVISION. �F � <br /> JOB ADDREBB/OR AHO C^^.--��- � L�/f L/�X/c-�1I7A / V I/ CITY_ � LOT MZr ��, /�/�4"�k:J <br /> Gvrt1En•e NAME�C•l.L��1 � l AoonEsa � F.�'�+L- PIgNEy� <br /> ADDRESS +� Jam( LICE J PHONE // <br /> BUB CONTRACTO��K�'STJ•cI � )// Jn-C�ADDREBS/C-�/ Z[�[.� I. / A%% . LIC BION -f. �'!� <br /> TYPE Of BEIRC WORK: NEW INSTALLATION •REPMWADIXT1ON ❑ DESTRUCTION ❑ <br /> IND SEPTIC SYSTEM PERMITTED IF MOM SEWER IB AVAILABLE MTHIN 200 rEET OF RUILDINOJ PFAC TESTIH 1 1 HOW MANY <br /> AnpSe.aew <br /> INSTALLATION WILL SPEWS: RESIDENCE❑ COMMERCIAL OTHER ❑ <br /> NUMBER Of IMNO UN10:_ NUMBER OF BEEMOOMB' NUM.En OF N.IPLOYEEB: -'T 5 ['TT �'X't CT.✓e lJ.�` <br /> CHSO <br /> ABACtEp OF IL TO A DEPTH Of O FEET:` T� PPMUMP SOIL CHARACTER: �^ WATER TABLE DEPTH T <br /> Tc) <br /> .SEPTI"ANIVOWASE TRAP ❑TYPEIMFO [Y>'1/ �j(.aI ZQ ,CAPACITY �(p )�I NO.COMPARTMEMB IAL <br /> PRO TAEATMENT RANT 1:1W <br /> DISTANCE TO NEAREST: ELL FZ'.P'i FOUNDATION PROPERTY LINE <br /> LIFT STATION❑ SIZE TYPE Of PUMP SAND OIL SEPARATOR IENCLOSEO BVSTEMI��� <br /> LEACNNO USE %)M:kO.A LENGTH OF LINER Z) V 1 FUJI(... DISTANCE 10 NEAREST:WELL �C,' ,Y FOVNDAPOW '✓�'I F PROPERTY LINE <br /> FILTER NEI ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERIV UNE <br /> M <br /> MOUNDED ❑ OTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LME <br /> SEEPAGE NTS ❑DEPTH BRE NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SUMP ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LME <br /> DISPOSAL MRON ❑WOTM LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LIN[ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIO APPLICATION AND THAT 1HE WORK WILL M DONE IN ACCORDANCE WITH BAN JOAOUIN COUNFY OTOINANCEB AND STATE LA..AND,RULER <br /> AND SIR "L THEBAN JOA COUIrtY.NOMEOWNERORLIOENSED AOFM'B mONATVRE CERTIFNS TIN FOLLOWING'ICEMIFV TNATMTNEPEREORMANCF OF TILE WORK PORNSIICN <br /> TARN PEWAfT M IBSVE 1 All NOTE ROY ANY PERSON M SUCH A MANNER AB TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWN Of CALIFORNIA.- CONTRACTOR'S HIRNO Of, <br /> s L RACTINO BI TUNE CETITN S THE FOLLOWMO:'1 CERTIFY THAT IN THE PERFORMANCE OF THE MW FOR N111CII THIS PERMIT IB ISSUED.I SHALL EMPLOY PERA 001 NUBJECT TO <br /> NE Y C r�IPER IAWB Of IIFORNA.- THE APRJCANT MUST CALL N TOURS IN ADVANCE FO EOMREO INSPECTIONS. COMPLETE GRAWINO BELOW. <br /> TITLE: ' V DATE: 7 I <br /> Ij <br /> ROT RAN MRAW 10 SCALER SCALE •IA <br /> 1. NAMES OF PRIVETS 0R ROADS NEAREST TO OR BOURDIN)THE POPErtlY. 4. LOCATION OF HOUSE SEWAGE MBPOSAL SYSTEM OR POMBED <br /> 2. OUTLINE OF THE PROPERTY.WRH DIMENSIONS ANO NORTH DIRECTION. EXPANSION OF SEWAGE WSIOBAL SYSTEMS. <br /> 2. DIMENSIONED OUTLINED AND LOCATION OF ALL E%IRTNA)AND PROMSED STRUCTURES. S. LOCATION OF WELLR WNNN RADIOS OF ONE HUNDRED FIFTY PT.ON <br /> INCLUDING COVERED AREAS OUCH AS PATIOS,D IVEWAVB,AND WAW8. THE POPERfY OR ADJOIMNO PROPERTY. <br /> 03 <br /> � Q <br /> 01 <br /> tj/c,�vo <br /> oc <br /> E4;F- <br /> AUG <br /> U <br /> 4,UDINI�,.,,1NrV _. <br /> 1'U01 I, RLS..1 i'5FRVICEti <br /> iJVtRONMENTAt HrMTH DIVISION <br /> FOR pEPARTMFNI USE ONLY <br /> LPRX:ATION ACCEPTED BV l.V \—"'�� " GATE' (O/ I ` AREA: f\ <br /> rMS.RT OR BUMP INSPECTTIOIOJJIIBY,�F CF✓,yL- DATE <br /> ) '�/ / FINAL <br /> INSPECTIONBY Q /DATE <br /> LDDRONAL COMMENTS: S I 1 ct y� �YV�jT � 6�'LEE.VA (J 1J-P / <br /> i',�, A44-7- C,.c 1 .,. .. 1 A . 0, �.. n. L 1 _I I _ n n <br />