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OWNER NAME LA�012. W FCK-IVU>IC3){�'ryl PHONE W"t m <br /> L46"4-L4461 — <br /> OWNER ADDRESS +, c�n r'��`l�'/-}�R�S 'F�i�J�pI C- -r �{ , of CrtY/STATEfLIP 2 f <br /> CONTRACTOR �"OJZ , <L]�!Y/l=` 4 ] !a LLdJV� �Ny PHONE 7k!"7"'./AT��" Z-�7.�/S� Znr <br /> ' CONTRACTOR ADDRESS :_01 (. tlj-d-C.-S7 IS tI , (Q� CITYISTATE/ZIP t�-'j✓NVZT l//yF `1SZ'tlJ <br /> LICENSE Pt-42 ❑C-36 OTHER NUMBER 5�EXPIRATION DATE a` ,,w (001 <br /> ' WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: G NEW INSTALLATION Er REPAIR/ADDITION Q ENGINEER DESIGNED]ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Z RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ' 0 SEPTICTANK TYPF/MFG CAPACITY Bal #OFCOMPARTMENTS <br /> 13 GREASE TRAP TYPE/MFG - CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ' O LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES O LEACHING CHAMBERS #OF LINES I LENGTH OF❑NES LI O I ft <br /> ' <br /> DISTANCE TO NEAREST WELL COO -F ft FOUNDATION �u0 i- {t PROPERTY LINE 30f ft <br /> 0 FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ' O MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft II <br /> 0 SUMPS WIDTH ft LENGTH ft DEPTH It <br /> ' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> 0 DISPOSALPONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft . <br /> SEEPAGE PITS NUMBER Z WIDTH _SG If It DEPTH7� I It <br /> DISTANCE TO NEAREST WELL IGt21+ ft FOUNDATION —740f ft. PROPERTY LINE It <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM]24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-,PLEASE CALL(209)953-7697 g <br /> ' SIGNED ��"`�1�4 TITLE \fa1V-t �t'�C.iT iTF-- DATE <br /> 1 1 <br /> J I <br /> Q S N E <br /> H <br /> IX <br /> ' .._DEPARTMENT �SLY <br /> DatApplication Accept O Area _ __ploy�ee i �9y <br /> Final <br /> ._ <br /> Inspection B Date � � ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/Sump Soil Character: <br /> COMMENTS OL-LD 4-oT- f- zE /12 <br /> ' �y�C�'�%(v FF/ __ ` �r-.� �Pvr✓�.- �..Tl-.., .sls-�.. � / Y �Kl �//1�.".!/!�L _ <br />