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Ilk <br /> 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 2275 Bacon Island Orad CITY/ZIP Stockton <br /> CROSS STREET Bacon Island Road APN 12905014PARCEL SIZE'1(IT,; <br /> e <br /> 0 <br /> Reclamation District 2028 510-719-3470 <br /> OWNER NAME PHONE Iif <br /> OWNER ADDRESS 343 E.Main Street CITY/STATEZP Stockton CA 95202 <br /> CONTRACTOR W.C.Maloney,Inc. PHONE 209-244-7090 <br /> CONTRACTOR ADDRESS Po Box 30326 CITY/STATEIZIP Stockton Ca 95213 <br /> LICENSE 7 C-42 C-36 OTHER C-21,A NUMBER 718243 EXPIRATION DATE 1-31-20 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION L <br /> INSTALLATION WILL SERVE: RESIDENCE 7 COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES - LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> ATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM OU C U_IRED FOR INSPECTIONS-PLEASE 0 953-7697 <br /> SIGNED i/tom TITLE Safety Director DATE 51B/20 <br /> B e e a t t a c Y. e d A <br /> RFC HENT <br /> y 01 ?070 <br /> N�RD AIN C <br /> A�TH� pgRTMEN7-Y <br /> DEPARTMENTU EONLY <br /> Application Accepted Date Area Employee ID#�;`' <br /> Final Inspection By LA Date S - ZO ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil o Depth of t: PiVSumpit Cha racte <br /> COMMENTS 6 Wv� <br /> E O <br /> PE SC Received Checkfll Amount Date Permit] Invoice# Permit ID# <br /> Code INFO Ca Remitted Service Re uest# <br /> i Ld 1 075 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4!14!18 <br /> �d833� ES <br /> 1 <br />