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(209( 468-3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ... (Complete in Triplicate) <br /> APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW(DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> OAGUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1110.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> SOB ADDRESSOR APNt c�/U% �f - CITY '�•-�-•� �`TS �J LOT SME_ <br /> p� <br /> OWNER'S NAME I`P X�+fH.O/IH/���I'T>.�T C n ADDRESS }� �a /!yR [� PHONE •I6 'J"�-�c Y=� <br /> 'ONTRACTOR �T ` U`C ��IT-L ADDRESS 10-f U� 14 2- ITJ4,r<•,Z-AUAi A LICt lOw�7�d PHON�B�'�rf'Y15 <br /> SUB CONTRACTOR ADDRESS lK! PHONE <br /> 'YPE OF SEPTIC WORK: NEW INSTALLATION ❑ REPAIRIADDITION DESTRUCTION <br /> -YO SEPTIC SYSTEM PERMITTED IF PUBLIC SEWER IS AVAILABLE WITHIN 200 FEET OF BUILDING.) PEO TESTW I I HOW MANY <br /> Appaaatlon t <br /> VBTALIATION WILL SEWS: RESIDENCP45 COMMERCIAL ❑ OTHER ❑ <br /> IUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:J NUMBDI OF EMMOYEFJ: <br /> CHARACTER OF SOIL TOA DEPTH OF3{fEXT: /.PIT/SUMP SOIL CHARACTER: �i WATER TABLE DEPTH <br /> SEPTIC TANIGGREASE TMP pI TYPSIMFGrQC COZ IC ` CAPACITY NO.COMPARTMENTS 2 <br /> •KG TREATMENT PLART❑ DISTANCE TO NEAREST: WELLPROPERTY LINE <br /> _ `'-fes FOUNDATION <br /> UFT STATION 11SIZE TYPE OF PUM�Pf S r OIL SEPARATOR(ENCLOSED SYSTEMI <br /> LEACHING LINE '-0 NO.A,LENGTH OF ONES O. O ; � - DISTANCE TO NEAREST:WELL /Gv Y FOUNDATION /1' Y PROPERTY LINE �� r <br /> ILTER BEI ❑WROTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY UNE <br /> MOUNDED m❑G•1WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION-76-- <br /> PROPERTY UNE <br /> SEEPAGE RTe Im DEPTH �`S c SIZE �- " NUMBER Z DISTANCE TO NEAREST:WELL/&0 FOUNDATION 'o PROPERTY LINE le. <br /> .UMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> IISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WRH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> '.NDHEGULATIONSOFTHESANJOAQUINCOUNTY.HOMEOWNERORUCENSEDAGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-ICERTIFVTHATINTHEPERFORMMCEOFTHEWOIKFORWHICH �. <br /> HIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAM OF CALIFORNIA.- CONTRACTOR'S HIRING OR <br /> 'UB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: -I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PENMR IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> 'SNOWMAN'S COMPENSATION LXABS/SOF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR AU <br /> REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. T <br /> :IGNED% �- , "S TITLE: f- DATE: <br /> PLOT PLAN(DRAW TO SCALE)SCALE <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> t DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, T S. LOCATION OF WELLS WTTHIN RADIUS OF ONE HUNDRED FIFTY FT.ON _ <br /> �. INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. K THE PROPERTY OR ADJOINING PROPERTY. <br /> r- — UT— (` <br /> s� <br /> ,F ilt <br /> ' _upi — <br /> sa ,yla� , <br /> U � � <br /> � c3la <br /> � II <br />