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I - — _.._._ ......___. nM1I.LL]lLIJ Mt IV �f Lrr r—�I^y�■ �err� <br /> OWNER NAME P-086s r DELADDRESS �y <br /> T, CITY/ZIP- �^/NG1�'n� 95.2•4' PHONF. (2 897~ 2.500 <br /> CONTRACTOR�IU-�� � M L�RInof i _ ADDRESS/_ p J_(� pox Z/f'o <br /> CITY2IPS <br /> ��/ T _ � ZyI -- -- .. _-- PHONE l w/� 33L 7 0/.3 <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: X Y TOWNSIIIP'30 RANGE g SECTION- IF <br /> PERC TESTIS)A HOW MANY____1 APPLICATION N: /'A a oL <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITI(,)N ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER _ �+ <br /> NUMBER OIi LIVING UNITS:_ NUMBER OF BEDROOMS- NUMBER OF EMPLOYEES:— Li <br /> CHARACTER OF SOIL TO A DEV-,H OF.I FEET:-. PITISUMP SOIL CHARACTER: __.„ WATER TABLE DFRI'H <br /> ❑SEPT)(-TANK)GREASE T RAP )'YI'F1Mf G _ __ CAPACITY NUMBER GFCO.L(PARTMENTS 1 1 J <br /> ❑PKG'TRF,A'1'MRNTPLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY IJNh' _ <br /> ❑LEFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(L•NCLOSH)SYSTEN'U <br /> ❑LEACHING LINE NUMBER&i.F'NCfI'H OF LINEN / INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION _ PROPERTY LIVE <br /> ❑FILTER HFI) WII7l'H ,__ LHN(.;rll DEPTH - <br /> DISTANCE TO NEAREST- WELL FOUNDATION:___— PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH_ DF.ITH _ <br /> DISTANCE TO NEAREST: WELL FOUNDATION __- PROPERTY LINE- <br /> El SEEPAGE <br /> INE-❑SEEPAGE PETS WIDTH LENGTH ­.....,... DEPTH <br /> y DISTANCETONEAREST: WELL FOUNDATION PROPERTYLINE— <br /> ❑SUMPS WIDTH LENGTH DEPTH <br /> DIST'.ANi:F.''fU NF:ARf:S'f: WFTL , -.F'(')(INDATION PROPfiRT'Y I.INE <br /> ❑DISPOSAL PONDS W'IIYI'I I LENGTH DEPTH <br /> DISTANCE TO NEARFS 1': WELL _ FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFI' T I HAVE PREPARES APPLICATION AND THE WORK WILL BE DONE:IN ACCORDANCE WITH SAV JOAQUIN COUNTY t7 <br /> ORDIANCES,S LA S,AVD RULES EQD RF.f.I:LAT10Ny OF SAN JOAQUIN COUNTY. <br /> SIGNED: I'I'1'LF.:__- (�f7►Gr DATE: <br /> i <br /> 41 <br /> IT- <br /> d,v : <br /> titi I(D: h .;i.: <br /> I <br /> F0 DF:PA RTNENT USE ONLY /+`' _ <br /> APPLICATION ACCFP'TED BY: V �A ! _., —_ I M 1 40'T S — DATE:�L-� , Q <br /> TANK,PIT,ORSI:MPINSPECrl-:I) _ DATE:_) <br /> FINAL INSPECTION Bt <br /> COMMENTS: <br />