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-INTRACTOR J • l u' -.! ADDRESS/ �/ �I��^li C}2'FN'(.�iJ�Q.C.-d UCi �I 1 PHONE <br /> _1BCONTRACTOR ADDRESS UCS PHONE <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIR/ADDITION DESTRUCTION <br /> O SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER 15 AVAILABLE WITHIN 200 FEET OF BUILDING.) MC TEST(.)1 1 HOW MANY <br /> Appllontlon I <br /> INSTALLATION WILL SERVE RESIDENCE COMMERCIAL❑ OTHER 13"BOR OF LIVING UNITS:)_ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> -IARACTER OF SOIL TO A DEPTH OF 3 FEET: MT/SUMP SOIL CHARACTER: WATER TABU DEPTH <br /> SEPTIC TANK/GREASE TMP ❑TYPEIMFG CAPACITY NO.COMPARTMENTS <br /> ^ G TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL__ FOUNDATION PROPERTY UNE <br /> LIFT STATION❑ SIZE TYPE OF PUMP G SAND OI}SEPARATOR(ENCLOSED SYSTEM) /d 7r <br /> Ly l_ 52� DISTANCE TO NEAREST:WELL � � FOUNDATION le.A PRDPERTY UNE <br /> -MACHING UNE P NO.4 LENGTH OF LINES <br /> RLTER BEM ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> OUNDED ❑WIDTH �" LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> �� <br /> �.EPAGE RTS DEPTHi y_SIZE NUMBER D16TANCE TO NEAREST:WELL AO FOUNDATION Q{ PROPERTY UNE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> 1SPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> THEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT INTHE PERFORMANCE OFTHEWOPK FORWHICH <br /> 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 / <br /> UB ONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO l/ <br /> .KIRKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DMWING BELOW. ^ <br /> r... I <br /> //SIGNED X <br /> ` , '"tri T� TITLE: n' DATE: <br /> PLOT PLAN(OMW TO SCALE)SCALE 'W <br /> �{. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE P ROPEPT . 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTUNE OF THE PHOpERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, B. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> r <br /> b <br /> N � <br /> I <br /> ✓ C <br /> Q�,.c� <br /> W+�ZOVED <br /> DEC 119 1999 <br /> z SAN JOAQUIN ejOj jN r <br /> yz zs t: PUSLIC HEALTW81mvtl <br /> � <br /> P 1� T� �`,r (Z— EPdvI&ONh1FNTALNFA <br /> LTH 01, bio <br /> `f <br /> FOR DEPARTMENT USE ONLY -T I <br /> APPLICATION ACCEPTED BY DATE: C� -AR ARA:-7--1 <br /> TANK,PIT OR SUMP INSPECTION BK__ DATE / / FINAL INSPECTION BY DATE I2 �` <br /> ADDITIONAL COMMENTS: CQ-l' I O" d S <br /> { L7 f <br />