Laserfiche WebLink
OWNER ADDRESS F �O �� CI'1'YlS'fATE/7,IP M10be-s1 C/ (, <br /> CONTRACrOR yzi cf, —___ PHONE <br /> CONT'RAC?UR ADDRE_ , c�_3 CITI'/STATE/ZIP <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER � � EXPIRATION DATE ~ <br /> WATER TABLE DEPTTI: A GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST(S) NLAtBER _ LAND USE APPL ICATION 14 <br /> TYPE OF WORK: ❑ 'NEW I.%S1'ALLAT'ION ❑ REPAIRIADDITION ❑ ENGISEERDESIGNED/ALT"ERNA'TIVE <br /> REPLACEMENT ❑ DFSTRUCTION I <br /> INSTALLATION WILL SERVE; X RESIDENCE COMMERCIAL ❑ OTIIER_ Q`�1 <br /> NUMBER OF LIVING UNITS: -� NUMBER OF BEDROOMS: M l NUMBEROF EMPLOYEES: <br /> Jif SEPTIC TANK TN'PF./MFG __��1'1( : C CAPACITY I�0� gal ?OF CUMPARTMENTS off, <br /> ❑ GREASE TRAP TYPFJMFG CAPACITY gal #OF COMPARTMENTS _ <br /> ❑ PKC TX PLANT DISTAN('ETONLARE:?1': WELL (�, ft Fou DATION R PROPERTY LINE _ _ LCot- _R <br /> ❑ LIFT STATION SIZE TYPE OF PIMP ❑ SAND OIL SEPARATOR(ENCI.OsED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS OF LINES ca _ LF%r rH of UNEs 60 R <br /> DISTANC'ETONEAREST WE:.L FOUNDATION R PROPERTY LINE _)t..J�J'>}' ft <br /> ❑ FILTER BED WIDTH _ ft LENGTH _ ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH R <br /> DISTANCE TONEAREST WELL __ _19t FOUNDATION— R PROPERTY LINE _ ft <br /> SUMPS WIDTH .2 fI LENGTH is -- R DEP"rH Ib A <br /> DISTANCE'r0 NEAREST WELL. _1= ­R FOUNDATION.�D ft PROPERTY LINE — ft <br /> ❑ DISPOSAL PONDS WIDTH _ R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL. _ —ft FOUNDAT;ON ft PROPERTY LINT R <br /> ❑ SEEPAGE PITS WIDTH R LENGTH _ ft DEPTH ft <br /> DISrANC'E TU NEAREST WELL fl FOL'D;llATIUN ft PROPERTY LIkF li <br /> I HEREBY CERTIFY THATI HAVE PREPARED THIS APPLICATION AND THE WARY.WILI.BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGI'LATIfINs OF SAN JOAQUIN COUNTY. <br /> IN M�'M 4 R ADVA. NO CE REQUIRED FOR INSPECTIONS-PLEASE CALL(2091 Q53.7697 <br /> SIGNED V _ TITLE DATE <br /> I , <br /> I <br /> � n <br /> I Q <br /> S <br /> D <br /> — (c <br /> EL1 <br /> b <br /> I C'ILLI <br /> DEPARTMENT UJOE ON y f�� <br /> Application Accept ed P _ Date Q_ Arca Employce ID#_�� <br /> Final laspcerion B� pate _d ❑ IS PERMIT-Approved by <br /> Cliarecter Of Soil to f 3 Ft: Pit um Soil Ch tcr: <br /> COMMENT, 6 �� 7 -!f l a 4w <br /> Oy <br />