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NUMBER OF LIVING UNITS: <br /> � CJoNTTY gal #OF COMPARTMEP <br /> ❑ SEPTICTANK TYi FG /'d•'A/At/.t B r I�— CAPACITY gal #OF COMPARTMEP <br /> ❑ GREASE TRAP TYPE/MFG <br /> ft FOUNDATION it PROPERTY LINE <br /> ElPKG TX PLANT DISTANCE TO NEAREST: WELL <br /> _ <br /> ❑ LIFT STATION SIZE <br /> TYPEOPPUMP ❑ SAND OIL SEPARATOR(ENCLO& <br /> #OF LINES LENGTH OF LINES <br /> LEACH LINES ❑ LEACHING CHAMBERS ? <br /> DISTANCE TO NEAREST WELL _ft FOUNDATION ft PROPERTY LINE <br /> ❑ FILTER BED WIDTH <br /> ft LENGTH ft DEPTH <br /> ft FOUNDATION_ft PROPERTY LINE_ <br /> DISTANCE TO NEAREST WELL <br /> WIDTH ft LENGTH t2 DEPTH _ <br /> ❑ MOUNDED ft PROPERTY LINE_ <br /> DISTANCE TO NEAREST WELL R FOUNDATION <br /> WIDTH ft LENGTH ft DEPTH <br /> Ll SUMPS ft PROPERTY LINE._ <br /> DISTANCE TO NEAREST WELL It FOUNDATION <br /> El DISPOSAL LENGTH ft <br /> DISPOSAL PONDS WIDTH DEPTH— <br /> ft PROPERTY LINE_ <br /> DISTANCE TO NEAREST WELL ft ft LENGTH ft DEPTH FOUNDATION <br /> ❑ SEEPAGE PITS WIDTH ft PROPERTY LINE_ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION <br /> _ft <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C( <br /> / TE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> RY 2/ UR ADVANC NOTICE REQUIRED FOR INSPE TION�ISL-PLL/E�ASE/�(j LL,p(109)953-7697 <br /> TITLE <br /> SIGI)dL�'D �f�t� / G��JG7 70Y V�(�(/ � DATE <br /> 2b� <br /> t. <br /> Z�/h�b�(� <br /> r i , <br /> 6. L� <br /> 7L <br /> - DEPARTME {[� E ONLY <br /> Application Accepted ey <br /> Date �T Area Employee <br /> Final Inspection By Date 0 ❑ SPECIAL PERMIT-Approvec <br /> Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �n�m� aT1F ZG <br /> L/Ilit��� <br /> PE SC Received Amount Date Permit/ Invoice# <br /> Code INFO B Cash Remitted Service Re uest# <br /> ONSITE <br /> 42-01-001 <br /> 12/2/02 <br />