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V� <br /> Jill <br /> a'r1 other fT Delta Depth of Grout Seal <br /> � TYPa of Grout ~- <br /> I'1 Public r' Surface Seal Installed by <br /> 1 �Approx. Depth I astern <br /> I I Inipation E — Stats Work Done �. <br /> Type of Pump H.P. <br /> Repair Work Done U Sealing Material i Depth <br /> I Well Destruction ❑ Well Diameter _ P $b <br /> Filler Material ; Depth <br /> Depth <br /> j TYPE Of SEPTIC WORK: NEW INSTA 11-35!1210 180 <br /> lnstallation will serve: Residence <br /> : Number of living units: Numb UPGRADIENT ENVIRONMENTAL CONSULTANTS 1Z S9��- <br /> i <br /> Character of soil to a depth of 3 feel: i. 4111 82ND ST <br /> SACRAMENTO. CA 95826 � 1 <br /> SEPTIC TANK O Type/mfg! - $; ��.� ,_.l <br /> PKG. TREATMENT PLT.❑ PAY TO THE __- <br /> 1j Distance tf d ORDER OF L L A <br /> I LEACHING LINE Cl No. & Lenj ~ <br /> I <br /> FILTER BED n Distance to <br /> [}1 Bank of Aflf<t <br /> (916) .2301 <br /> Cameron Park Brexh 7539 1516! rrP <br /> I 1 Depth 4970 Cameron Palk 10- <br /> SEEPAGE PITS Cameronr - <br /> SUMPS LI Distance to µEMO �r�Car� " <br /> � rrr 2 3 3 9 6,110 L 2 t, 3118 <br /> DISPOSAL PONDS O f, L 2 &OQQ 3 S131:0L8O <br /> I hereby certify that I have prepared this ! <br /> rules and regulations of the Sen Joaquin. Y r .. r r,m fvrrormance of the work for which this permit is issued. I &hall not <br /> Homure <br /> e owner or licensed agent's signature .. -•• tl <br /> kaon in such manner as to become subject to workmen's compensation laws of California." Contractor's hiring or sub-contracting m <br /> employ any Pe performance subject <br /> of the work for which this permit is issued. I shall employ parsons subject to workman's compansa <br /> certifies the following:"!certify that in the <br /> I _ tion laws of California." <br /> The applicant 4st cs for all rpgyired inspections. Complete drawing on reverse side. I <br /> fY/ (J6/' Ju +, Date: <br /> Title <br />