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�j'• ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS +7/5 E !;SL fi:jP)PP JA A119 NCE- 1AA/E- CITYIZIP_�TQ9_k.Ti� 933,4'- ,1 A 3^" <br /> iCROSS STREET rROTA ' /SD - APN �/ ]-J - �-/rL7�I2 PARCEL SIZE G Cf- <br /> OWNER NAME '�TOe-k-rom ,u/Ajpu at-r-"aA C&,rTP-jz, PHONE_jLL,::5- ,z <br /> OWNER ADDRESS ?/S F. FOPP/fln(D CITYISTATE/LP <br /> CONTRACTOR C11,FfA1 E V r,0,&1jjZj-r1" PHONE G,i B F <br /> CONTRACTOR ADORES. _ P D • A, 3 1q-� CRYfSTATEIZIP <br /> LICENSE ,.C42 C-36 OTHER(2&0E?5;1�79 NUMBER ExPIRATION DATE t1�3(J/1 2- <br /> �—WA ER TABLE DEPTH: 3�� R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST 0_1_— I BUILDING PERMIT# LAND USE APPLICATION p1001)eA <br /> TYPE OF WORK: C NEW INSTALLATION I I REPAIRIADomoN - ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT - DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES' <br /> ❑ SEPTIC TANK TYPE.M=G _ CAPACITY _ gal #OFCOMPARTMENTS_ _ <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OFCoraPARTMENTS <br /> OWTAMMTONEAREOT: WELL it FOUNDATION R PROPERTY LINE it <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKOTXPI.ANT ❑ $AND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACHIINES ❑ LEACHINGCHAMBERS XOFLINES LENGTHOFLJNE. It <br /> DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY UNE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH _ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY UNE <br /> LI MOUNDED WIDTH R LENGTH ft DEPTH R <br /> DISTANCE TO NEAREST NIELL It FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELLit FOIXdMTION R PROPERTY UNE <br /> it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH h DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION _R PROPERTYUNE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH I; DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PPOPERTY LINE R <br /> I!EREBY CERTIF AT I HAVE PREP THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE HATH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> rdl" U VANCE NOTICE REQUIRED FOR INSPECTIONS•LPP'�LLwEASE CALL(209)953-7697 <br /> SIGNED TITLE 4WN`-'t DATE Z ZZ-72 <br /> 1 <br /> T <br /> D <br /> 012 <br /> E F p <br /> OE E:NT <br /> DEPARTMENT UV ONLY <br /> Application Accep*Dsof <br /> Date -t- 1- Z Area Employee IDX_ <br /> Final Inspection B _ _ Date / U SPECIAL PERMIT•Approved by <br /> Character of Soil t : Pit/Sump Soil Character. <br /> COMMENTS �A 1 ODf t 27 7 y 5AIt1l6Gt,' LG Z m� C� <br /> �T Z-z <br /> PE SC Received Check#/ Amount Permit/ Permit LOX <br /> Code INFO By Cash Remitted PaloI Service Re uest X Invoice X <br /> '2 I MAX <br /> a2�t <br /> 10,'4,07 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> J'Av <br />