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� <br /> NON-REFUNDABLL PER1,614-1. CALL j209)9534 69" INSPEC TIONS <br /> Joe ADDRESS —C#TY/ZIr, <br /> CROSS STREET APN i 3Z�e,co PARCEL SIZE <br /> OWNER NAME 4I-KT-1A13IliL- sc-,;i lqr�- PHONE- (Z'LYI) --- <br /> � <br /> LICENSE C-36 OTHER NUM13E EXPIRATION DATE <br /> _ CONTRACTOR ADDRESS CITYISTATEIZIP L-Z,�Ok, <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> M"PERC TEST ��� rlff��IT ft 8P.-14/0 2 LAND USE APPLICATION# 1'/ <br /> TYPE OF WORK: LI NEW INSTALLATION 0 REPAIRJADDITION �ENGwErR DESIGNED/ALTERNATIVE <br /> n REPLACEMENT_ n OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE 0 COMMERCIAL 0 OTHER <br /> ~ <br /> o s,rncrxwx npE/wm oAP^CITYo* o",CONIPARTMENTS <br /> o sns^ssm^p ,YP"IM= uAP^ ," nal o"~COMPARTMENTS_ <br /> DISTANCE,"NEAREST: w*LLo ,O"°=,m° n PROPERTY LINE_ft <br /> ~~ o LIFT STATION SIZE TYPE o,,oM,______o pxnrxPLANT o SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> o LEACH LINES // LEACHING CHAMBERS <br /> x",u�." �swerxopu°"" o <br /> ~~ o."°="=NEAREST =,`,_______^ ,O"°mm^° n PROPERTY LINE ^ <br /> u FILTER BED WIDTH it LENGTH x m~= n <br /> DISTANCE:,°NEAREST WELL oFOUNDATION n PROPERTY LINE_v <br /> o muvwocu WIDTH it LENGTH n DEPTH it <br /> DISTANCE TONEAREST WELL_nFOUNDATION_it PROPERTY LINE n <br /> — o uvmpo WIDTH __n L"°=," ^ n",= it <br /> DISTANCE TONEAREST WELL it ,"""=== ^ PROPERTY LINE_it <br /> o DISPOSAL PONDS WIDTH it LENGTH x o",= it <br /> DISTANCE,°NEAREST WELL________ ^ FOUNDATION —ft PROPERTY LINE ^ <br /> _ o SEEPAGE PITS NUMBER— WIDTH x oc,," it <br /> DISTANCE,"NEAREST °~u_______ x FOUNDATION __n PROPERTY LINE_III <br /> I HEREBY CERTIFY THAT I 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 /> _ ADVANCENED .— TITLESFA'Z-f DATE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 m <br /> u, <br /> ` �� �n� <br /> — ^ <br /> _ <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date-- Area Employee 10# 1:-" <br /> _ <br /> As <br /> Character~Soil— <br /> Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS (,71 c,i'l- <br /> PE SC Received CCheck --,�mount Date Permit/ Invoice V P rmitIDII <br /> — <br /> ONSITE WASTEWATER TRT?,INTSYSTEM PERMIT <br /> m*` <br />