Laserfiche WebLink
OWNERADDRESS r CITV/STATE/ZIP / 7 <br /> CONTRACTOR I/ L' ! 'h,'L��<OJ'1 PHONE 3(� -/ 3 / C <br /> CONTRACTOR ADDRESS /�' .N n CITY/STATE/ZIP <br /> L' ii« Z. 4 <br /> LICENSE ❑C-02 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X V <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE / <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> ' NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R <br /> ' ❑ FILTER BED WIDTH R LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It (_ <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE R <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R (� <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH it ) <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R <br /> ' 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I> <br /> MINIMUM 24 HOURA NCJE NOTICE REQUIRED FOR INSPECTIONS-./PLLEASE CALL(209)953-7697 U <br /> SIGNED ei TITLE CIN rez DATE <br /> 41 <br /> O <br /> UI G <br /> ' NIR MN <br /> H <br /> C <br /> DEPARTMENT JOSE O; LY ' <br /> Application Accepted By e— Date T as Q Area Employ=16# 71' <br /> Final Inspection By �� Date !/.24 /o Z ❑ SPECIAL PERMIT-Approved by 7j <br /> ' —r—�� <br /> Character of Soil to Depth of 3 Ft: � Pit/Sump Soil Character: <br /> COMMENTS .j 3'F Qi�1, .N rwnn/:nc A , Kl,.y 3a v I.417� <br />