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OWNER NAME t'MIC c-oycle ; ADDRESS Yy s- MlLtz- ALL <br /> CITY/ZIP Got)i 4152¢Z PHONE �yh X2'1 23 5 <br /> ' CONTRACTOR NAL O. Q Soti /fN_f-> ADDRESS <br /> CITY/ZIP {�� 95 740 PHONE 2'�l- �Jb-] <br /> GEOGRAPHICAL INFORMATION: COO+RDIANTES: X Y TOWNSHIP_RANGE-SECTION <br /> ' PERC TEST(S) ( ) HOW MANY 1 APPLICATION S: <br /> TYPE OF SEPTIC WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ DESTRUCTION <br /> ' INSTALLATION WILL SERVE: ❑RESIDENCE ❑COMMERICIAL ❑OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET: PIT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> ❑SEPTIC TANK/GREASE TRAP TYPEIMFG CAPACITY NUMBER OF COMPARTMENTS <br /> ❑PKG TREATMENT PLANT DISTANCE TO NlfREST: ,-.WELL FOUNDATION PROPERTY LINE <br /> ❑LIFT STATION SIZE TYPE OF PUMP SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ' ❑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 <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SEEPAGE PITS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ❑SUNIPS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> Q DISPOSAL PONDS WIDTH LENGTH DEPTH <br /> DISTANCE TO NEAREST: WELL FOUNDATION PROPERTY LINE <br /> ' I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDIANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: TITLE: fjEj21ZalF&l74-►g1-'E- DATE: 'z w 13 <br /> OF <br /> s^ <br /> ' O GCt law O <br /> ` 1 <br /> EuT� <br /> Ao -. <br /> pp .y �� +'�I 1 i <br /> I �pTO �y jH$ ° y1N 4113.. <br /> ® 9_ Al}OIAI� 9 !O <br /> La iv Is T <br /> Gail <br /> - -'- --- / vn(/\���A} FOR DEPART ONLY <br /> APPLICATION ACCEPTED BY: �&h�1 ..��J�f DATE: <br /> TANK,PIT,OR SUMP INSPECTED BY: DATE: <br /> FINAL INSPECPI N BY: <br /> COMMENTS: �� llJ N •S <br />