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..vw.a P.O.BOX 388,4Z .,SAH JOAOUIk ST 5T0�" 1H,CA 96201-0388 f ) (2091468.3420 k rc7, �• - NON-REFUNDABLE PERMIT EXPIAES 1 YEAR FROM DATE ISSUED l 7 ICBmpieta in Tripkataf APPLICATION IS HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAH JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANDARDS Of SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. IIP - f. C_ JOS ADORESSAOR ArNI CITY 4 L07 SIZE OWNER'S NAMEADDRESS ♦ PIfONE !' I7� Y c �)� N+P_r Y31`4 S'lf s_ADDRE58 LIC. PHONE 3(oo CONTRACTOR —r SVS CONTRACTOR , ADDRESS O .� 5 / �� PHONE S/�[ j TYPE OF SEPTICWORK: NEW INSTALLAMON r"ANUADDIToN 13 DESTRUCTION El I IND SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN TOO FEET OF BUILDING.] PERC TESTM I I NOW MANY — INSTALLATION AppSotlan I ' ! INSTALLATION WILL SERVE- RESIDENCE LQ COMMERCW.13OTHER❑ �S /r G[] s 7 C/ / Q ' NUMBER OF LmNO UNITS: NUMBER OF BEDROOMS: —3 _._NUMs91 OF 9MPWYEEB: a CHARACTER OF 6DIL TO A DEPTH OF 3 FEET: PrT/SUMP SOIL CHARACTER: WATER TABLE DEPTH II - SEPTIC TANKIOREASE TRAP ❑TVPEFO CAPACrrY !u O NO.COMPARTMENT /M 6 PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: -ELL—IML-jet FOUNDATKIN D '," PROPERTY LINE LIFT STATION❑ SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ) LEACHING LINE [3 MD.i LENGTH OF LINES•„r� — Y/J K. - Dk6TANCF TO NEAREST:WELL FOUNDATION Lo t PROPERTY LINE 'T FILTER CEO ❑WROTH LENGTH DEPTH DISTANCE To NEAREST:WELL FOUNDATION PROPERTY LINE - MOUNDED ❑WIDTH �..R LENGTH DEPTH DISTANCE TO NEAREST:WELL y.�FOUNDATION ��}}P--ROPERTY UNE I[ - IEEPAOE NTA ❑DEPTH A`J SRE A A NUMBEA3 DISTANCE TO NEAREST:WELL d2 f/FOUNOATIQN_LL(PRDPERry LINE_ 1 COMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE f i DISPOSAL PONDS ❑wtDTH IANGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATOH PROPERTY LINE f . I HEREBY CERT]FYTHAT i HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY,HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTMES THE FOLLOWING:'10ERTIFYTHAT HI THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO SECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUWRMA-' CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH TH13 PERMIT NS 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. J� SIGNED X A�/ _ TITLE: 2G-� L DATE• %"/r/S PLOT 4 @RAW TO SCALE)SCALE 'to 1.NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY,WTTH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES 6, LOCATION OF WELLS WRHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS DRIVEWAYS,AND WAk1K8 THE PROPERTY OR ADJOINING PROPERTY/ ........ I, .. 3�Q� tiTB�.. ..... .. .. j' 1 40 0 i .. . .. . y . . .. . ... .. p.T3Nsjl ... . . ......, ... . ......<. ............ ............ ........ ........... ! . iR SEA ..79g5 .. � HEA aEfi4FLc k VJIRONPiEfJTPL�r!nRiH .. . 4F E -- I :: . . . FOR DEPARTMENT USE ONLY r, I� S .a 6 944- r, APPLICATION ACCEPTED BY C DATE: !� -- ": 2 LLL � r 1 �. i