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113o.r 4,tl <br /> Sr^, '� <br /> S JOAUUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388.SO4 EAST WEBER AVENUE.STOWOK G-Ami- 88 <br /> (209) 458-3420 '° <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> h <br /> F IComplals In TripBssts) <br /> APPLICATION IS HEKSY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TR-LE,CHAPTER 9-1110.3 AND THE ST FOS OF SA,fN JOAOUIN COU PUffi!C HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION.JDB ADDRESS/0111APNIIJZ/ �,r� ,( CITY •`+ •– LOT SIZEJG�"^-' <br /> .. OWNER'S NAME ADDRESS <br /> CONTRACTOR ADDRESS LIGIN PHONE <br /> 6118 CONTRACTOR ADDRESS 11C1 PHONE <br /> -TYPE OF SEPTIC WORK: NEW INSTALLATION nEPAMIADDITIOIC ❑ DESTRUCTION❑ <br /> WO SEPTIC SYSTEM PERMITTED IF PUBLIC-SEWER 19 AVAILABLE WITHIN 200 FEET OF BUILDING- pE1C TEST{8 S 1 HOW MANY <br /> ppptlmtlon N' <br /> t. <br /> INSTALLATION WILL SERVE RESIDENCE❑ COMMERCIAL I] OTHER❑ <br /> NUMBER OF LmN0 UNITS:,_ NUMBEI OF BEDRO0 NUMBER OF EMPLOYEES: T y <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET- PIT U P SOIL CHARACTER: WATER TABLE DEPTH Q / <br /> SEPTIC TANICMREASE TRAP ,XTYPE/MFO _ L"' CAPACITY NO.COMPARTMENTS'7 /��` <br /> PKO TREATMENT PLANT❑ DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE Z.ZA–L—f <br /> LIFT STATION❑ SIZE TYPE OF PUMP ,I SAND OIL SEPARATOR IENCLOSED SYSTEM) �p� ,t" <br /> FUEACHING ONE ND.NI LENGTH OF LINES V DISTANCE TO NEAREST:WELL UNOATWN 1 PROPERTY LINE �ys„• —6 <br /> FILTEI BED' ©MOTH LENGTH DEFTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> FMOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> SEEPAGE PITS ©DEPTH SFZE _ NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> 6UVIp6 ❑WIOTH IENGTH DEP14! DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> I DISPOSAL PONDS ❑WIDTH LENGTH DEPTH - DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> 1 HE1E6Y CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND STATE LAWS.AND RULES <br /> ANDREOULA B FTHESAN JOAQUINCOUNTY.H OWNERORLICENSEDAGENT'S SIGNATURECERTIFIES THEFiOLLOWM.'ICERTIFYTHATINTHEPERFORMANCEOFTHE WOFKFORWHICH <br /> THIS PEfwr7 SHALL NOT EMPLOY N IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S"WOW O <br /> SUB-CON'TI ACTT StONATURE CEATMS FOLLOWI :'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH Tk118 PERMIT(S ISSUED,i SHALL EMPLOY PERSONS SUBJECT 7D <br /> WOFKM 'S NSATION LAWS OF ALIFORNIA.' APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. COMPLETE DRAWING BELOW. ` <br /> TITLE DATE: , <br /> SIG X i' <br /> �-- 1 PLOT PLAN{DRAW TO SCALE)SCALE ler <br /> R 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRDPO`SED <br /> ` s 1. N ES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. EXPANSION OF SEWAGE:DISPOSAL SYSTEMS. <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION, S. LOCATION OF WELLS WITMN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> 3. DIMENSIONm OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, THE PROPERTY OR ADJOINING PROPERTY. <br /> INCLUDE COVERED AREAS SUCH AS PATIOS DRIVEWAYS AND WALKS -- -- - . <br /> ki <br /> r <br /> F + `...... 'o <br /> N <br /> 1AJA <br /> fi <br /> '....... .. . <br /> fi......... ......:t H <br /> �p <br /> AY <br /> N 2 3 1991 <br /> ............. ...... ..... ....... <br /> -7 <br /> PLi6!IC.HTtT}i............. <br /> .............. <br /> ............ <br /> .............. <br /> -1 L r <br /> SERVICES <br /> ..... -- ECdl�)aQN14AEfVTAL Hir4f T�Dllggfp <br /> �.. a - <br /> s:o .-.:. .. . <br />