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OWNER NAME_, - }n1, -AYEj—y!y-6e— � ADDRESS_^ Z <br /> 'CITYIZIP_.---f""I"GEkFV C `Q_ ,� __ PHONE NUMBER <br /> CONTRACTOR_ W VLW ✓.ICLt./ <br /> 4 .CZ___�_� ADDRESS____ _ <br /> PHONE NUMBER_ <br /> GEOGRAPHICAL INFORMATION: COORDINATES: X Y-_ _TOWNSIIIP.._RANGF__SECTION <br /> TYPE OF SEPTIC WORK: INSTALLATION WILL SERVE; NUMBEROF LIVING UNITS: <br /> �r NEW INSTALLATION 0 RESIDENCE NUMBER OF BEDROOMS: <br /> ❑ RFPAIR'ADUI'FION ❑ COMMERCIAL <br /> Cl DHSTRUCTION U OTHER__._ _. NUMBEROFEMPLOYEE-S: <br /> ❑ ENGINEEREWALTERNATIVE <br /> CHARACTER OF SOIL TO DEPTH OF3': PITISUMP SOILCHARA(:7ER: WATFR TABLE DEPT if: <br /> -- <br /> Q PERC TEST IS) HOW MANY_ _ APPLICATION k_ <br /> !pl SEPTIC TANK TYPF;MFG/A0jf o . . CAPACITY I ZSR/ G 4 Of COMPARTMENTS 21 <br /> ' ❑ GREASETRAP TYPE%MFC CAPACITY_ R OF COMPARTMENTS <br /> ❑ PKGTXPLANT DVWANCETONEAREST: WELL FOI:NDATION PROPERTY UNE <br /> ' ❑ LIFT STATION SIZE _ __ IYPF OF PIIMP_- _ SAND OIL SEPARATOR(7CI.OSEDSYSTEM)_ v. <br /> LEACH LINE 4OFLINE•S: LF.NGTHOFLINES: G) oM1TwNCe TO NEwRFrT: WELL FOUNDATION0 PROPERTY LINE <br /> INFLITRATOR CHAMBERS: TT <br /> ❑ FILTF.RBED WIDTH__ LENGTH DEPTH___ DIATANM"I%EARbT. WELL FOUNDATION PROPERTY LINE <br /> ❑ MOUNDED W'IUTH__ LENOTH__ DEP711__ DVS 4MT:TO NE.AEST: WELL_ FOUND&TtON PROPERTY LINE <br /> ❑ SUMPS WIOTH__ LENGTH__ DEPTH_ mRIANCeTOREwRGtr. WELL` FOUNDATION PROPERTY LINE. <br /> ❑ DISPOSAL PONDS WIDTH__ LENGTH DEPTH__ DI.STANCFWNEAREST: WELL_ FOUNDATION PROPERTY LINE <br /> ❑ SEEPAGE PITS A—_—, _ DIAMETER_ _ DEPTH Df?TA.NCETONEARFST: WELL__ FOUNDATION PROPERTY LINE ' <br /> I HEREBY CERTIFY TI I II F PR PARED I PPLICATION AND THE WORK WILL BC DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS <br /> AND RULES AN D REGULATIONS OF SAN JOAQUIN COUNTY. <br /> TNI UM A VANCE NOTICE REQUIRED FOR INSPECTIONS' -PLEASE CALL <br /> �(2/0�9)469.3423 SIGNED: _TIT'LEI Y.' E)UJ VtO , DATF,: 3 1p DZ, <br /> ' I <br /> { _ <br /> 1 i <br /> AAP <br /> 2�U ' <br /> I <br /> L EtdVlft©NM1AEPlT F1EtL]�i. _ <br /> , ; <br /> — PERMIT/JEERVIC <br /> T, 7 <br /> 7. <br /> L <br /> : <br /> I _ <br /> I <br /> .1 <br /> ; <br /> le?j <br /> ! T <br /> DF.PAATME'NI <br /> �T 1/TI/.E LWL U <br /> APPLICATION ACCEPTEI �t _ 71011 �DLSTRICT� LOCATWN <br /> 'INSPECTED t%%�T( _ DATEry/5;ak4---tTTsss F_PERMIT fINA YES DATE,_ __INSPECTOR:_____ <br />