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ti< <br /> JOAOUIN COUNTY PUBLIC HEALTH SERVICES �- <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOK 388►304 EAST WEBER•AVENUE.'SMoMN. CA 9520 t. <br /> (209101-3420 <br /> 0 EFUNOAB E S OM ffiS E <br /> APFLIGITON M It Mly MADE TD THE BAN JOAGIIIN �Ci1Ep1Eh tT>RBpt>t1 <br /> ,JOIIOI Cow"� COUNTY FOR A PERMIT TO CONSTRUCT AM=*WALL THE WORK VESCRIBED. THIS APPLICATION M MADE IN COMPLIANCE WITH am <br /> TITLE.CHAPTER 9-1110.3 AM THE STANDArM'Of c" AOUM Cp�y pyo <br /> •Isle ADDREwpR AFNI 0 OD ,f L/. HEALTH 6ERVIrCEB ENVIRONMENTAL HEALTH OMMM. 1 <br /> OWNBR•B CRY •'•rri— LOT M7�' Brj! <br /> AODREsi ` �7 r <br /> AOdllEssf�/ c. �� � pNpNEa�•, <br /> i11B OD/rTRACTOR ' GCr-=� PHONE�� <br /> ' ADOREsi <br /> uCr ,•_PHONE <br /> .TYPE oP tEPT101L om. -�� <br /> NEW NtiTALLAIIDN 0 ��AIRrAOgTTOM bEiTRUCTgtI 0 <br /> VOMP' SMEM PW MTITFO F PUBLIC SEWER M AVARABU WrrHI 200 FEET OF e <br /> i - PMC TntLRI I I HOW MANY <br /> MISTAUULININ IMILL i61VE REi1bEHCE❑ CO ArpEnueon <br /> . MMERCIAL❑ OTHER 13 <br /> i NIMH OP UAIMq UMTR mumiitm OF BEDROOMS: NUINe[11 OF tEe/LOYEEt• <br /> CHARACM OF SIM TO A OEM OF 3 FEET: pT BOIL CHARACT0 <br /> MPM TAINUWM4M TRAP ❑'TYPEAMFO WATER TABLE DEPTH <br /> CAPACITY NO.COMPARTMENTS <br /> PLCO TREATMEIT PLANT DISTANCE TO NEAREST: WF1L <br /> FOUNOATON PROPERTY LINE <br /> LET STATIOIt 0 SIZE TYPE OF PULAP SAND OIL BEPIIMTOR IENCLOBEO SYBTEMI .. <br /> UD�IG wo r 1l HO,i LENGTH OF LINES DISTANCE TO NEAIED WELL O <br /> F&TM M 13 WIDTH S FOUNDATION PROPERTY LINE <br /> WOTN DEPTH ONTANCE TO NEAREST:WELL FOUNDATION___ PROPERTY LINE <br /> 13 LENGTH DEPTH OISTANCE TO NEAREST:WELL FOUNDATION <br />- i�AtIL FITS �DEPTH - PROPERTY 11NE <br /> Bf� NUMMM DISTANCE TO NEAREST:WELL�y�FOUNDATION PROPERTY LINE <br /> GURIIle 13 WIDTH tENOTH OEPTII DISTANCE TO NEAREST:WELL FOVNOATION — <br /> IIISFOeAI.POIOi 13 wom PROPERTY UNE_�w <br /> STH DEPTH -DISTANCE TO NEAREBTi WELLT•OUIV0/1TION PROPERTY LINE- <br /> 1 HEIESBT CNWW THAT I HARE FRIPARED TM APPLICATOR THAT THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOAOUEi COUNTY <br /> AND LLS{N/1TIO11GUIM IMALLNOT AOWYj y.HOME ORLICf1i�0A0EHT'BSIBNATVRECt"ThMTHEFOLIOWNK#t•ICERTIFYTHATW PERFOIgAANCEOFTWVftMWM%"CH <br /> TIEiFE1MNT tS Mi11E0,1 SHALL NOT EIMPLO 1f ANY FEIIeO/A A MANNER AS TO BECOME SUBJECT TO WORKMAW4 COMPENSATON LAWS OF CAt1FOIMEA•• CONTRACTOR'S NWAM OR <br /> SIl/ I TUBE CE E FOLLOWING: C THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS tsKmMp I SHALL EMPLOY PERBOIIS SUBJECT 0 <br /> WTIL AN'S CO ION F NLA" THE. T MUST CALL 24 H0f/118 IN ADVANCE POR ALL R�IMSFGCTONS, COMPLETE ORAWIIO BELOW. <br /> To <br /> X <br /> TITLE• DATE• �!/ <br /> PLOT PLAN DRAW TO SCAM SCALE.-w .- <br /> 1."Alm OF STRWWOR ROADS NEAMST TO OR BOUNDING THE PROPERTY. 4. LOCATOR OF NDVBE SEWAGE DISPOSAL SYSTEM OR PROPOSED �. <br /> 2.Ounm OFT1E PAOPERTY,WITH DMADMONB AND NORTH DNIECTON, E LOCATION <br /> N OF OUK WAeEDmwI iYRTBMi. <br /> 3• D 1FRISM AND LOCATION OF ALL EXISTING AND PROPOSED STRtICTURE6, G. LOCATOR OF $EwA WITHIN RADIUS OF ONE III/1R1RED FIFTY FT.ON <br /> lI1RE lE 0b11OM MEAS dUCH AS PATN?S, <br /> y....:.......b... THE PROPERry OR ADJOINM PROPERTY. <br /> ...?....................j,.l� .. .. -. - .. ., - .. <br /> YB,AND W B. <br /> ry + <br /> .:. ..i.... <br /> ......4......:......y......:... .n......:.. - .. - .. <br /> ....:.......:.... r <br /> d� <br /> �,� <br /> ,rk. <br /> ¢,�.. :. <br /> �, i I <br /> : ...:..... .............:...... L �f.Cf7...C� 4; <br /> .4......:......e...... .......... .....:.......:.. .`.... <br /> i K <br /> .... ..:....... <br /> ......h. /y r .. <br /> ;.... <br /> i <br /> ...y. <br /> 6 <br /> ......:... t <br /> ......p.. :......�...... .: ..:......: : ...`.� .. <br /> . • :.............................,............. i <br /> : <br /> 1 F <br /> : <br /> iG ...:.. '.... <br /> ......................:..............;.... � � - i <br /> i <br /> 4.....:.......:......:..-....} <br /> e <br /> ....:............................ <br /> : <br /> J r <br /> �Ql <br /> FOR DEPARMQNT LME ONLY - <br /> APAICATWII ACCEPTED BY /fir 7 : <br /> "' � '• � w'. DATE-—7 I <br /> IANC.PTT OR SUMP INSPEcrlDll By - • �•�aP - .. - .. <br /> VATE��FINAL INSPECTION BY <br /> =ADDFnDNAL MIT* a-#:Ce.4 oe <br /> -- �r 46 /k <br /> a <br /> ACOGUNTOO Y, AE7/ FACT �' J' S G r, tL o, <br /> FE CODE FLO IItFO teff m lTE1 OIiBC - ASH RECIRVED BY DATE wt i llu ET NIEuRiER /� <br /> MIVOICF <br /> V Q.06 <br /> Pub.Hedlh Sen.-EMft.114(3186} <br />