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7. <br /> OWNERADDRESS ����D V • j, _- r �' \/� P C,IT,/STATE/ZIP "rl.�r' fT CI'TJ,3L <br /> CONTRACTOR _� I PHONE <br /> CONTRACTORADDPESS CITV/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE_ <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X V �. <br /> J <br /> r ❑ PERC TEST M BUILDING PERMIT# LAND USE APPLICATION Yr <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION P ENGINEER DESIGNED/ALTERNATIVE V <br /> ❑ REPLACEMENT ❑ DESTRUCTION r <br /> r INSTALLATION WILL SERVE:— ❑ RESIDENCE COMMERCIAL ,r -Q]rHER. <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPFJMFG_ CAPACITY gal P OF COMPARTMENTS <br /> r ❑ GREASETRAP TYPE/MFG CAPACITY - gal R OF COMPARTMENTS <br /> ❑ PKGTXPLAM1T DISTANCETO NEAREST: WELL R FOUNDATION fl PROPERTY LME fl <br /> if <br /> LIFT STATION SIZE 8Y )e4-r, TVPEOFPIIMP `�- `/_k ❑ SAND OIL SEPARATOR(ENCLOSED SYsrEM) <br /> r v \ <br /> ❑ LEACH LINES O LEACHING CHAMBERS R OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft F'OLNDATION R PROPERTY LINE ft <br /> - ' ❑ FILTER BED WIDTH ft LENGTH .__ ft DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 11 PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH B LENGTH 11 DEPTH It <br /> r DISTANCE TO NEAREST WELL — ft FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMP$ WIDTH fl LENG14 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE h <br /> r ❑ DISPOSAL PONDS WIDTH ft LENGTH_ .- It DEPTH R <br /> DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE _� fl <br /> ❑ SEEPAGE PITS NumBER WIDTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE ft <br /> ' 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONSOF SAN JOAQUIN COUNTY. <br /> � NI��IM/UUjjM,,24 HOUR ADVANCE NOTICE REQUIRED FOR INSPE r�IONS-P ASE LL(209)953.7697 <br /> ' SIGNED �LLU Lam�Q� � TITLE /A DATE <br /> r I <br /> ' NIQYaID 3D' , <br /> � AL.DRIVENAT <br /> a DD' <br /> AZ. AKND <br /> AGAEIDdiED E-' <br /> ` MI WMIC iavc AND NELL H!F r <br /> 'L2.GED FlELD NPIEE 1 <br /> ,.. I T I _ •., i �,••...��MI GREA6E NTERCe M TANK <br /> a <br /> r ' r <br /> 1E)AG.PAVED TARD 1 <br /> ' i AND ETRa�er ENTe 1 <br /> 2 <br /> I <br /> tilIl ` <br /> r - _ <br /> t P <br /> l_y----- s <br /> ... � a <br /> ` ' sTORn DRAmAGE I O <br /> ' I�i\l l -iy11 Exle•NG ..S,i Ll"STATCNMAIERtALS <br /> ; <br /> , <br /> 1\\ II <br /> 5 i i1EP'1 <br /> , <br /> I <br /> le —mac_ e*R��eIGs f <br /> T—IEIAG PA•IED DANB'IAT--____- _ 1 <br /> rApplication Accepted l !� ___�1'__' a__Dare ---�--- IDAI c <br /> Final Inspection By / Date ❑ SPECIAL ERMIT-Approved by <br /> iCharacter of Soil to DePof3 it/Sump Soil C aracter. <br /> Comm-, T$ Centr ��- <br />