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OWNER NAME__`?rQ✓��-TCS ��•°JY� •E"����ADDRESS luVW -70• l \`h `vk,-% ` %4^c11 <br /> ' CITY/ZIP ' 1 C`.�p�l ..,`pr �.• � _,_ PHONE NUMBER^/� <br /> CONTRACTORORR-•��}��(�`�yy_✓�""��`-'-�•+ ,7�•+�`G ADDRESS W�wJ E• Y r �N � �•• <br /> CITYIZ,IP_ 1.! .�� �/ PHONE NUMBER CzCnn 94`3-13 5 <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X_ _N __ TOWNSHIP RANGC. _SECTION <br /> TYPEOFSEPTICWORK: INSTALLATION WILL SERVE; NUMBER OF LIVING UNITS: <br /> ❑ NEW INSTALLATION y❑ RESIDENCE NUMBER OF BEDROOMS: <br /> X RF.PAIRlADDITION )( COMMERCIAL NUMBEROF EMPLOYEES: <br /> ❑ DESTRUCTION ❑ OTHER--- <br /> 0 <br /> THER _❑ F.NGINEEREDIALTERNATIVE �� <br /> CHARACTER OF SOIL TO DEPTH OF 3-:_S*t*0AtA&PITISUMP SOIL CHARACTER: _ WATER TABLE DEPTH: <br /> TD Z� <br /> PERC TEST HOW MANY_-_� V <br /> _ APPLICATION " 2—_�_ <br /> ❑ SEPTIC TANK TYPE/MFGCAPACITY Y OF COMPARTMENTS <br /> ❑ GREASF.TRAP TYPFMFG CAPACITY R OF COMPARTMENTS <br /> ❑ PKGTX PLANT DISTANCETONEAREST: WELL FOUNDATION PROPERTYLINF <br /> ❑ LIFTSTATION SIZE__ TYPE OF PUMP SAND OII.SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINE P OF LINES: LENGTH OF LINES:_ DISTANCE TO NURM- : WELL__ FOUNDATION PROPERTY IJNF. <br /> INFLITRATOR CHAMBERS: 1 <br /> ❑ FILTER BED WIDTH LENGTH__ DEPTH__ DRIANCETONEARMT: WELL FOUNDATION PROPERTY LINE LT <br /> ❑ MOUNDED WIDTH LENGTH DEPTH DIRTANCETUNEARER: WELL FOUNDATION PROPERTY LINE r <br /> C <br /> , ❑ SCMPS WIDTH LENGTH DCPTII._ D6IwNCFiOnrwRFR: WELL FOUNDATION PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH LENGTII___ DEPTII DLSTANCk TONEAREaT: WELL FOUNDATION PROPERTY LINE ` <br /> ❑ SEEPAGR PITS R DIAMEIER _ DEPTH__ DISTANCE TO NEAREST; WELL_ FOUNDATIONPROPERTY LINE <br /> — <br /> I HEREBY CERTIFY THAT 1 RAVE PREPARED THIS APPLICATION AND THE WORK WYLL RF,DONE IN ACCORDANCE WITH SAN JOAQUIN LOUNTV ORDINANCES,SPATE LAWS <br /> AND RULES.AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NIM HO R V'ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 � <br /> ' SIGNED: _TITLE: t•. NDATE: <br /> AYIDMIII I <br /> ... . . : ..�-...y.. .: _ .. :. -.-- <br /> .:..._...__ } j _ mw <br /> �__�...�. ..1......__..__1 <br /> P <br /> i : <br /> .. ._ mw{ 1-4 , <br /> -. <br /> i' <br /> •• . i. ��Y_4/1�L�I1 <br /> , <br /> PT <br /> r �1 I9H7Fr• { i.. <br /> I <br /> T' <br /> j. <br /> DF.PARTMF.NT SEOUL. /�I/ `/ <br /> APPLICATION ACCEPTED BY: _ _ IIAIE Z- V/AREA Ems( EMPLOYEE ID� ISTRWT _�LOCATION / <br /> ' INSPECTED BY S(c'� C DAFT. RO v PERMIT FI NAI. YES DATE WL <br /> INBPECTOR <br />