Laserfiche WebLink
AA <br /> ' OWNER NAME y I``��° f-4eptl- ADDRESs g"z' Atc— <br /> ta <br /> CITY/ZIP ��I7 9 �5ti4 PHONE 'Y��I " i a Z3S� <br /> CONTRACTOR_ �c: �a ��� � � �� '� a ADDRESS �� <br /> 1 <br /> CITY/7-1 � � PHONE ' �9�C3� <br /> d <br /> GEOGRAPHICAL INFORMATIP N: COOgRDIANTES: K Y TOWNSHIP_RvNGE_._._SECTIO <br /> 7 N <br /> ' PERC TEST(S)( ) HOW MANY APPLICATION <br /> TYPE OF SEPTIC WORK: Ll NEW INSTALLATION ® REPAIR/ADDITION ❑ DESTRUCTION <br /> INSTALLAATION WILL SERVE: 11 RESIDENCE ❑COMMERICIAL ®OTHER <br /> ' NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FE4T-. PIT/SUMP SOIL CHARACTER-- WATER TABLE DEPTH <br /> ®SEPTIC TANK/GREASE TRAP TYPFJMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ' Q PKG TREATMENT PLANT DISTANCETO NE REST: ,_;WELL FOUNDATION PROPERTY LIME <br /> LIFT STATION S[ZE_.__ TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ' 13 LEACHING LINE NUMBER&LENGTH OF LINES ! INFILTRATOR CHAMBERS <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑FILTER BED WIDTH LENGTH DEPTH <br /> ' DISTANCE TO NEAREST: WELL FOUNDATION; PROPERTY LINE <br /> ❑MOUNDED WIDTH LENGTH DEPTH Io <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE V <br /> 13 SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> — <br /> C3 SUMPS WIDTH LENGTH DEPTH <br /> ' DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> 13 DISPOSAL PONDS WIDTH LENGTH DEPTH Q <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE F®c <br /> ' I HEREBY CERTIIF'y THAT H HAVE PREPARED TH3IS APPH.HCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQpUIN COUN'T'Y <br /> ORDIANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, y� <br /> 0 <br /> SIGNED: T[TLE: �Ad �I DATE: <br /> I <br /> • B8�` 'fid ' '^�, �,. :.,, ,. '... <br /> ' is w �& ,ar <br /> I 8. � aI <br /> 70 ;A rI+ <br /> moll JG 9 ,o Lac Hti :alt+ c:�RIC; <br /> ■I7 is r , I ... +6 is � <br /> Ll <br /> r r 1n1 ■ NLr■M W, � I � <br /> ttttt <br /> FORDEPART LY <br /> APPLICA•tIOIV ACCEPTED BY: <br /> DATE: <br /> TANK,PIT,OR SLQv9P INSPECTED 8Y: _ <br /> ' MNAL IKSPECTI N 8S': I <br /> COMMENTS: <br />