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OWNER ADDRESS Fc%)/1I.�`?L)x I)3 I � ye r-'s�. CITY/STATFJZIP 5ny i Cf3.77 <br /> ' CONTRACTOR ✓l& y 2190 lCiA-7 0 '1 P�HON/EE <br /> CONTRACTOR ADDRESS 33Z-55 `�+ Qs/C�(J-r2Ti/G� R- QCrrY/STAACL/ZIP ' '�`Cy <br /> LICENSE ❑C-42 ❑C-36 OTHER A �- �•^f NUMBER 4JO 2-O 1 EXPIRATIONDATE��' <br /> WATER TABLE DEPTH:_ft GEOGRAPHICAL INFORMATION: Coordinates X Y_ <br /> PERC TEST(S) NUMBER LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE XCOMMERCIAL OTHER_ <br /> NUMBER OF LIVING.UNITS: _ NUMBER OF BEDROOMS: UMBEoPEEMPPLOVEG <br /> L3 SEPTICTANK TYPEIMFG �(L//A �� �� Lr CAPACITY_, OFfPARTME <br /> NTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> {J C 03 <br /> PKC TX PLANT DISTANCE TO NEAREST: WELL 9 Lf C ft FOUNDATION fl PROPERTY LINE ft <br /> O LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLoSEo SYSTEM) <br /> ' ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLRVES _ LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LME R <br /> FILTER RED NVIDIA —Wft LENGTH ft <br /> it DEPTH <br /> DISTANCETONE EST WELL ft FOUNDATION ft PROPERTY LINE Fl <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH H <br /> DISTANCE TO NEAREST WELL _ R FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH - R DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH _ R DEPTH ft <br /> DISTANCETONEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS WIDTH ft LENGTH R DEPTH ti <br /> DISTANCETONEAREST WELL fl FOUNDATION R PROPERTY LINE }t <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 /> HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 / <br /> SIGNED _ / Q <br /> TITLE_ I=-0�T►-6OL DATE / } �-3 <br /> F!i er becl r Prlm .Te <br /> 4500 sq ff <br /> FXISTIr G <br /> .. AsphaB <br /> _ _ <br /> LEACHF ELD Concrete <br /> 3200 sq ft : .. .;'M1is �pi•(G� �O <br /> f� <br /> tlBCirica <br /> W Panel Truck Bay <br /> f/ , <br /> DEPARTMENT�7rUSEONLY <br /> Application Accepted By O -,I Date' �Z"'�� Area Employ"IDN Final Inspection By �- /� Date 1Z�r Q Y `''ry) ❑ SPECIAL PERMIT-Approved by _ <br /> Chancier of Soil le Depth of 3 Ft: P{USump Soil Character: <br /> COMMENTS )IA/ fJ 4ft�ly c4. JA, fir✓ l /L 47� I�16f D/DPvl **,,v <br /> /�l L17'�sf/�7/�/fN17 flt' � t' ,� �;.���/Jtr/ /.K3 .!f/�' •f.ZO� <br />