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TYPE OF SEPTIC WORK: MSTALLAfIONWILL SERVE: 4UMBEkOFLIVING UNITS: ❑ NEW INSTALLATION ❑ RESIDENCE NUMBER OF BEDROOMS: REPAIR/ADDITION Of COMMERCIAL NUMBER OF EMPLOYEES: O DESTRUCTION ❑ OTHER _ - ❑ ENGINEERED/ALTERNATIVO: CHARACTER OF SOIL TO DEPTH OF 3': PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH: ❑ PERC TEST(S) HOW MANY APPLICATION# ❑ SEPTIC TANK TYPE/MFG CAPACITY #OF COMPARTMENTS___ N ❑ GREASE TRAP TYPE/MFG CAPACITY #OF COMPARTMENTS C r ❑ PKGTX PLANT DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ LirrSTATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINE #OF LINES: L..i LENGTH OF LINES: lot) DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE INFLITRATOR CHAMBERS: ❑ FILTER RED WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE: ❑ MOUNDED WIDTH LENGTH DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE �✓ 2_ ❑ SUMPS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ DISPOSAL PONDS WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE ❑ SEEPAGE PITS # DIAMETER DEPTH DISTANCETONEAREST: WELL FOUNDATION PROPERTY LINE 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. %11111N 24 HOAR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)468-3423 SIGNED: TITLE: T'n��}�� DATE: f �.__. ._. ............. _ . i --_-.......- ....-- .._.....}......_. _._........... ..... .......- .... ...................... _I. i .._ ..__.i, _........ .... ! -- - . - ..L.......... ._..._ ._.._.................................. ..__.r_.._............... ........... _.._._._..._....... _ __.._.......---........_... _ _..._..._...._.... .__ ........._ ... .. ... ................ .. :�: ... . --! - - .. ....._._..... - ....... . .. . .............. ...........i. .. i 1 i i I .. .. ! __ _ ... _..._ ._...j........_................._.....,..._.................._.............�........._..........._�... ._.........' -._.._.._.. _...---'-.._ _......._.............................t...._... _......._.'...... _... --.. .... ....__.. _ _ _ .._.._._....._. - ._!. .. ..... �. I ' : I .... ........... .._........_.._....._..._....._...._. i f 1 t L } �.._.._. -. _........ ,...-----..... ..................._... ..__._.!..._. ......._ _._.I .... 1 . '_... _...... -- - - - . i 1 ! i .. ..........:.._......_._...... __... - _. ...... _ -t- . -..;_... --E-----t ._.. � _ _._._(...-_.�.__ _. .. ........-. _... - _ - 1 1 --................'_.._...........__--.--'----. _..._...._..-....._...._'--._......_.........._-..._...._.._..._..._. ..-...._............I ..- '- -"-- — .. ... ......... - --- - -.- . - -- - ..........._...�'__.._ .._.. . I_.._y_.._..........._....i--....._.......................-;........_.........:...._._....(.........._ ..........I...._........._.-....t..........'.._........}............a.........._ ...... .......i...._......;............I...._..........._._;...._ -.G')�1..?J.1.4.!._`!:!_.._......._.*._.., ..........-- ---�...__.�.... r r �, ; ciWE _ ! i I '� _...._......._.._........_._... -. _._._..........._............-.__.i.._..- --._..__......._._.....__..-..._._..-...-'..._._. . _ - - - -- ! i _..... ........._�.._........._........ _.._ ;.. _........_.._........ _........_........_................i!....................._............. __.._.........I.._.._...............,.-_....._i.............._...... ........_.......--.. .�................._.......`........... ..... -.._...:......._......_........._._....i...__.....j..I.... _ - jj it , - f , { r I 1 i I 1 i ( SSA JC?AQ i IN CO NT ! ).._.... 1 _ _..........._ )..._..... I l��11 .. __.� �— f.............._. -_:_.{_...._.._.V....__,. ..._.i..... !... i ( 1 PU CIC IEAtTN J'€M DEPARTMENT USE IONLY �• ^--l1 7c�'�`p APPLICATION ACCEPTED BY: ^V� -"�"v DATE: '' •� AREA �)" EMPLOYEE IDq!�V`� DISTRICTLOCATION INSPECTED BY: ti - -` DATE: V PERMIT FINAL�YES DATE: Z NSPECTOR� COMMENTS:_ _ PG CODE SC INI'O AMOUNT .HEC ASH RECEIVED uA i I PERMIPSERVICE REQUEST# INVOICE# SEPTIC ID# REMITTED BY -11 REVrcEDK-15.01 - - - - -- _