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OWNER NAME 0014 Liles fh9-f-a—b ADDRESS P. 'G I '2�.4C. ' I I'�••I a}-'::.. ;_..- i :t._ ;..•�••.' <br /> CTI'YIZIP, FLa:W q3-7 7-7 PHONE <br /> CONTRACTOR WAL n_ ^jPZLS>Aj */C;&cr_ ADDRESS ZZ t4,- L'S'TZw <br /> C1TYrzIP CAW I PHONE_ 2-0`17- <br /> GEOGRAPHICAL INFORMATION: COORDIANTES: )( Y TOWNSHIP_RANGE SECTION__ <br /> PERC TEST(S) 1/y_HOW MANY I APPLICATION M: _ <br /> ' TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION 0 DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS:__ NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:__ <br /> CHARACTER OPSOILTO A DEPTH OF3 FEET: PIT/SUMP SOIL CHARACTER: _ WATER TABLE DEPTH_ <br /> ❑SEPI'IC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NEAREST: W F.I,L FOUNDATION PROPERTY LINE _ <br /> ' ❑LIFT STATION SIZE TYPEOFPUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) _ <br /> ❑LEACHING LINE NUMBER&LENCI'H QF LINES / INFILTRATOR CHAMBERS <br /> ' DISTANCE TO NEAREST: WELL FOUNDATION °ROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WBI.L FOUNDATION: PROPERTY LINE <br /> ' ❑MOUNDED WIDTH LENGTH_ DEPTH <br /> DISTANCF.TO NEAREST. WELL FOUNDATION PROPERTY LINE- <br /> D SEEPAGE <br /> INE❑SEEPAGE PITS WIDTH LENGTH _ DEPTH <br /> ' DISTANCE TO NEAREST: WELL FOUNDATION PROPERTYIJNE <br /> ❑SUMPS WID'T'H LENGTH DEFTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ' 13DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCETO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND'THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> I ORDIANCES,STATE/Lj W�S,�ANDQRULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: DATE:Z`PO�U� <br /> i <br /> Ell 41.1 �. <br /> I i <br /> WA <br /> .1 1 1111 <br /> 4 <br /> 1 <br /> i I <br /> _ I <br /> t II' I <br /> t ` <br /> i <br /> ' <br /> /] FORDEPAR (RENT/USE ONLY }r[/ 1/APPLICAT[ON AOCF.PTEO BY: `�� DATE: <br /> TANK,PIT.ORSUWWSPEC BY: <br /> FINAL INSPEI.TIONRY: 1e._;tk <br /> 1 <br /> COMMENT. - 7 ea <br /> �'6 C?6{ /l'tr r d�. r'✓- 1�.�ir..,. E ^ JS9 .�-,6a< �yo /.r. f.�F� ,o�.�,.E. �.�✓.�.a <br />