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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2028 Bacon Island Road CITY/ZIP Stockton r <br /> CROSS STREET Bacon Island Road APN 12905014 PARCEL SIZE <br /> OWNER NAME Reclamanition District 2028 PHONE 510-719-3470 <br /> OWNER ADDRESS 343E Main Stret CITY/STATE/ZIP Stockton Ca 95202 <br /> CONTRACTOR W.C.Maloney,Inc. PHONE 209-244-7090 <br /> CONTRACTOR ADDRESS Po Box 30326 CITYISTATE/ZIP Stockton.CA 95213 <br /> LICENSE r,:C-42 LlI C-36 OTHER C-21 A NUMBER 718243 E%PIRAPON DATE 1/31/2021 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDMON ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION <br /> INSTALLATION WILL SERVE: [I RESIDENCE COMMERCIAL Ll OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF CCMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF CCMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES h <br /> DISTANCE TD NEAREST WELL fl FOUNDATION II PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH II LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <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 /> IN UIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Safety Director DATE 4/28/20 <br /> RF Y^MRN <br /> S e e a t t a c h e d CF�VF <br /> O <br /> APR <br /> 28 ?4?0 <br /> Ili V Ro U/N co <br /> THDE QRT���Y <br /> 1 DEPARTMENT US ONLY <br /> Application Accepted !/ Date o C 0 Area S '/ Employee ID#�� <br /> Final Inspection By Date 5 I..I SPEC AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PIUSump S1 Character: <br /> COMMENTS O rD d 0`1 f <br /> �. PA <br /> L 'fi <br /> PE C Received Check#/ Amount Permit/Code INFO B Cash Remitted Date S rviceRe uest# Invoice# Permit ID* <br /> `�J J 75" 1�.� A40 sko"AIGTS <br /> 42-01 /n' 9 / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 167 i 7/�Y c% <br />