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^ONTMCTOR S r S i/k'I` s' ADDRESS I L C.IN'.EN7L'0-0.C.-d LICI�j1I PHONE :UB CONTRACTOR ADDRESS M# PHONE TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPARIADDITION DESTRUCTION NO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PFAC TESTI.1 I ]HOW MANY APWloetion P INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑ OTHER ❑ IUMBER OF"NO UNITS:—/— NUMBER OF BEDROOM&:_ NUMBER OF EMPLOYEES: :HARACTER OF SOIL TO A DEPTH OF 3 FEET: PT/SUMP SOIL CHARACTER: WATER TABLE DEPTH EEOTIC TANK/OREASE TRAP ❑TYPE/MFG CAPACITY NO.COMPARTMENTS PRO TREATNMIT PLANT❑ DISTANCE TO NEAREST: WELLFOUNDATION PROPERTY LINE UFT STATION❑ SIZE TYPE OF PUMP 0cf, SAND OIC.SEPARATOR IENCLOSED SYSTEM) l /a -,EACNNO LINE NO.t LENGTH OF LINES - O(�J f_ -q2 DISTANCE TO NEAREST:WELL / FOUNDATION /e-A PROPENTY UNE FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE ,ROUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE _iEEPAGE RTS 14 DEPTH SIZE 4-LF NUMBERS DISTANCE TO NEAREST:WELL 10 FOUNDATION Q� PROPERTY LINE SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION IMPERTY UNE DISPOSAL POND& [I MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE r_HEREBY CERTIFY THAT I HAVE PREPARED THIS APFLICATION AND THAT THE WORK WILL BE GONE 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 CERTIFIES THE FOLLOWING:*1 CERTIFYTHAT IN THE PERFORMANCE OF THE WOW FORWHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR r IUB ON'TRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO l! VOWMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTION&. COMPETE DRAWING BELOW. fn'///. //7 A//� SIGNED% 9 ` ' " -`"� TITLE: �b DATE: U PLOT PAN(DRAW TO SCALE)SCALE 'to �1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. 1 i s +,c N � � I � fid �~t 0AYM ... NT ....... FC lid ' DEC I;q 1994 Z SAN MAQUIN 00j)NT T HR� l� Past Ie I�EA�zEeravl 3 }, , ENVIRONMENTALAALTHal 1p FOR DEPARTMENT ME ONLY APPLICATION ACCEPTED BY DATE: Z _AREA:� —TANK,PIT OR SUMP INSPECTION BY DATE / I FINAL INSPECTION BY DATEI-1. /'Z7 / ADDITIONAL COMMENTS: /ZY_ R C 2 ✓+'-' Q Sa-++-C_ 421-1A