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UNbi I t VVAu I tVVA I tK I KEATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)6683620 <br /> NON-REFUNDABLE <br /> ,PERMIT CALL 209 E153-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSU <br /> TSED <br /> JOB ADDRESS Q &Z(e F LOPEXOPO LICiTYmP L-4f.jDE/J qS Z3 rL ya <br /> CROSSSTREET �1.(4�z')l�t(S Y AP{�N IeT1J''AIO"D) •F -O� PARCELS� I>O �• y <br /> • OWNER NAME -JV NOT'VINET'T I T-rA PHONE. 43 2--CA039 <br /> OWNERADDRESS I9b Z1P E. COPPE"POLICITY/$TATEIZP LJNbF-,-j,c . <br /> 1 � gS.2.3� <br /> CONTRACTOR L1%./970K GEo CNVhC0rJY{1(.%� TAT- PHONE 3b!p-o3�S �L <br /> CONTRACTORADDRESS �4,3-4- W• OAK— ST_. CmZ <br /> /STATEP "-D(. CA p( <br /> LICENSE QC-42 QC36 OTHER NUMBER EXPu ATON DATE <br /> p <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 'X PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNAME <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 0 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OFLMNG UN1 m. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACItt <br /> gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACItt <br /> - gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE 1t <br /> ❑ LIFTSTATION S¢E TYPEOFPUMP O PKGTXPLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS 0 O LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTYLINE ft <br /> ❑ FILTER BED won ft LENGTH ft DEPTH It <br /> DISTANCE TD NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIGTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYUNE ft <br /> ❑ $UMP$ WICTX ft LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DIBTANCETONEAREST WELLft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH R <br /> • DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R <br /> 1 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 /> M NIMU OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE GDNSVIir—RNT DATE <br /> I <br /> v J' .•.+��-COPPERDPONS 7—: ROID 4 - <br /> .Ig m. <br /> PARCEL' <br /> 3 8 COFPEROPOLIS ROAD <br /> 7C Lt pq/•�y <br /> Ey <br /> PARCEL <br /> ma• ❑ P �� ° PAIN, <br /> 9 n P8 <br /> —3 SSI$ pg -, �Zg2n y <br /> S • •DESIauTED REMAINDER' <br /> f G�TLV'J��LL.J1�' 2M WFC <br /> a@� ❑ <br /> - _ — .a <br /> DEPARTMENT UFE ONLYp <br /> Application Accepted By Date 3 L24-1,` Area / Employee IDA 1�1 T-0 <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 FC PWSump Soli Character. <br /> COMMENTS A2 O _ YET <br /> • PE SC Received Amount Data Pertnitl Invoice# Permf[ID# <br /> Coda INFO Cash Remitted Service ueSt# <br /> �u s L 3 S3L.d ' z8 S T70 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />