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I Appw—uon <br /> INSTALLATION WILL SERVE: RESIDENCE k COMMER ❑/J OTHER ❑ Il <br /> NUMBER OF LIVING UNITS:�_ NUMBER OF/NEDROOL L_ NUMBER OF EMPLOYEES: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: ­e /`jalti�PfT/SUMP SOIL CHARACTER. c � _WATER TABLE DEPTH <br /> SEC TANKJOREASE TRAP ElPE/M <br /> TYFG� O � <br /> CAPACITY lj NO. <br /> COMPARTMENT <br /> PTI6 <br /> PKO TREATMENT PLANT❑ INSTANCE TO NEAREST: WELL FOUNDATION PROPERTY UNE <br /> UFT STATION❑ SIZE TYPE OF PUMP `, SAND OIL SEPARATOR(ENCLOSED 8YSTEMI / <br /> LEACHING U �NE NO.6 LENGTH OF LINES - Y t7' DISTANCE TO NEAREST:WELL FOUNDATIONS PROPERTY UNE �/D <br /> FILTER BED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE <br /> MOUNDED ❑WIDTH LENGTH DEPTH-- DISTANCE TO NEAREST:WELL / FOUNDATION PROPERTY UNE <br /> SEEPAGE PITS DEPTH SIZE ILS NUMBER 'Z� DISTANCE TO NEARE8T:WEL�/-S�D FOUNDATIONS PROPERTY LINE <br /> SUMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERTY LINE _ <br /> DISPOSAL PONDS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATK)N PROPERTY LINE <br /> I HEREBY 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 E <br /> AND REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNER OR UCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FORWHICH <br /> THIS PERMIT 18 ISSUED,1 WALL NOT EMPLOY ANY PERSON IN SUCH A MANNER A8 TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR <br /> SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN'S COMPS ATION LAWS OF CALIFORNIA.* THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REGUIRED INSPECTIONS. COMPLETE DRAWING BELOW, <br /> SIGNED X / TITLE:_y'-�// DATE: 1 <br /> PLOT PLAN IDRAW TO SCALE)SCALE_ 'to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. 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 /> F.. ....� :.. ... .. _....... .... <br /> ---� <br /> E .. .. <br /> ... ..... ...... ... . <br /> ..;.. <br /> ......;........... ......?......:..............:.................. .. Q,r��. ... <br /> ......................... <br /> __.. ..... .... .....`. ........ ........ .. ........ .. .. . . .. <br /> .........................' ............ <br /> .. <br /> .. <br /> ......... <br /> a <br /> :.......:......:.... . . <br /> . <br /> _ .. <br /> .. ... ' <br /> .�. .. .. . � ...4.. TSN <br /> :................. z�.i . ..2�`¢a�. .1� <br /> r� <br /> .. ....:............................. ... . <br /> .. .... . <br /> : :............ . .. <br /> ...:.....:... ..:.... <br /> :..... .................................... <br /> .... <br /> .. . <br /> :.. .........:...........:......:. ...:. .. .:. .... .... <br /> ........:...... ...... ......:......:..............:............................;. <br /> . ........:.............:.. <br /> .........:... <br /> ..:.. ...;.. <br /> ...:.....:......:.... <br /> .:......:..... <br /> ..............:......:.... <br /> .:.. ..:... <br /> ,......... <br /> ..:. ..........:.. <br /> E.............t.......;.... .. [a;�iNl"Y.... <br /> .. ..... ..:.. ............ ....... <br /> ...................:. SAN E;;;iriJlN <br /> ;.... / �� �rNVIROI/Mi.tllrl i1�51t IHIDIVIS,10ty <br /> ZtZl-FOR DEPARTMENT USE ONLY A <br /> APPLICATION ACCEPTED BY <br /> DATE: ,� }n/,�A '°'� '�'7 <br /> TANK,PIT OR SUMP INSPECTION BY <br /> DATE / / FINAL INSPECTION BY V a kDATE l /2- <br /> / <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY: AIDI FAC# '� <br /> PE CODE FEE INFO AMOUNT REFUTED C14ECKNICASH RECEIVED BY DATE SR/PETiNNT NUMBER INVOICE f <br /> Pub.Health Serv.-Enviro.174(3/96) r �� <br />