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�- 3PPLICA.ICN :CR PERMI�_ j� SAN JAQUIY CCUNT'_7 PUBLIC x~• L-, �7$r" ' {1. C✓ � ��Q ( =I 13CIVMENTAL 97FAI.TH D I V I-S 445 N SAN J OAQUIY, PHCNE (209)se�3�E"^ P O BCM 2009, STC XTCN, CAi , r�f ,L+ ?t PERMIT =TEES 1 YEAR ?RCM OATILL (CzmD12Lz ;a a-�a Appl catlon Is hereby made :o Za.n ;oaqulz Couaty for a permit :o _cnst:sct and/or :aster ' :he vorz _ere:a applIcatlon is made in compliance with San ;caqui= County Crdinance Jo. 549 end :862 and the tu.ies sod :iesu:.ations of San Josquin County Public Heal*„h services. Job Address S'�Sri V-aefj 4 LL P,y Qd City ,70,7,'r?� Lot Si:e/Ac-csg- Owner's Narne f7/`1. 1_ Address � V�1N /yGL�� 1�GJ P}o" Contractor �/Y�/7 L %!i �/ iC/Y Address oC!' , -c ^ !/`! f{UP: _:cense Vo. "lone TYPE OF 'NEL LlPUMP• NEW 'NELL ^ 'NELL AE?I-4CCx+1EHT 7 :ES-RUCTICN Jv= of Service ieL PUMP INSTALLATION C SYSTEM REPAIR OT4ER _ Acnitor'_=g DISTANCE TO NEAREST: SEPTIC TANK SEINER LINES DISPOSAL =LO. ?RCP. lNE FOUNOAT'CN AGRICJLTURE 'NELL OTHER 'NELL ?ITS.SUMPS i INTENDED USE TYPE OF 'NELL P9C8L_=M.AREA C:NS7RU'C71CN SPEC;FICATiCNS C7 Industnal ❑ Open 3ortom C .Manteca Dia. of 'Ned Excavation Dia- of 'Neil Casinq ❑ Domestic/Private ❑ Gravel Pscx C Traci Type of Casing Specfiranons _ ('1 Public Cl Other fl Delta Depth of ;rout Seat Type of _rout I I Irripahon -Approx. Depth I I Eastern Surface Seat Installaa ov Reoair Wort Done C Type of ?•.mo rl.?. State Work Dene 4�1 Wed Destruction C Watt Diameter sea._'3 rTar='" ' "e?ta F Depth F__ler `lsterlal i Depth "C1 TYPE OF SEPTIC WORK: NEW INSTALLATION/- RE?AIA/AOOITICN 1 i DESTRUCTION I (No seouc system perrtvtted ,I puolic sewer 4 avatiaole rvr(htn:W feet.: Instsilatton will serve: Residence _L_ CommercAi _ Other Numow of living units: / Numoer of bedrooms -3 Character of soil to a depth of 3 feet: C-L/4`,- Water table depth SEPTIC TANK. @ Type/Mfg ?��rP�Ctrsr )OL4 Capacity /��'0 No. Compartments PKG. TREATMENT PLT. ❑ Method of Dismsai Distance-to_nearest�_�Kef / �utsdation I� _Property I Irv. SHOO- _- LEACHING UNE ?I No. 3 Length of tines � — s-S� Total length/size / FILTER BED ❑ Distance to newest: Wail Foundation `�� Property Line Soo b 3 SEEPAGE PITS j/( Depth ��' Si2f Number�/9' SUMPS LI Distance to nearest: Well 00 Foundation /�Z_4; Property Line � eo r DISPOSAL PONOS ❑ 1 hereby certify that I have prepared this appi"oon and that the work will be done in accordance with San Joaquin county ordin.snces. state laws, and rules and regulations of the San Joaquin County Horne owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permt is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued,1."it employ persons subtect to workman's compensa- tion taws of California." The applicant it Call for aft required inspections. Complete drawing on revere side. Signed X Title: Date: FOR DEPARTMENT USE ONLY Application Accepted by I Date A Pit ,,{{\G� /{t Inspection by � ✓� Date Z Final Inspection by t � tr0 Date � f AddiSgr omments: Applicant - Return all "- pies to: San Joaquin County Public Health Services Environmental Health Permit/Services 445 N San Joaquin, Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTER CASH RECENED BY DATE PfAMIT,NO. • EN13-24 IIIEV. 1/ EH t4a♦ - //11