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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAH JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-SToCKTON CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 2O9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2276 Bacon!Sland Orad Z 7 "'—/Z 574,957CITY/ZIP Stockton <br /> CROSS STREET Be—ISlarnd Rood APN 1296501: PARCEL SIZE ��7r � > <br /> Is <br /> OWNER NAME Reclamotion Distri=2028 PHONE StD-7193470 <br /> OWNER ADDRESS 343 E.Main Street CITY/STATE/21P SIOCklon CA 95202 ' <br /> CONTRACTOR W.C.Moloney,Ina PHONE 209.244-7090 <br /> CONTRACTOR AoDREss Po Box 30326 CITYISTATE1Z p StOCkIDn Ca 35213 <br /> LICENSE C42 'C-36 OTHER C-21.A NUMBER 718243 EXPIRATION DATE 1-31-21 <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> ' TY E OF WORK: <br /> NEWINSTALLATION REPAIR/ADOITtON ENDIr1EER DESIGNED lAL7}E..Rry'ATIVEl <br /> REPLACELIENI OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION S e Tp L-1 C )A n <br /> INSTALLATION WILL SERVE: C RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYFE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DUITANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 7 LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ FILTERBED WIDTH R LENGTH R DEPTH, h <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED WIDTH R LENGTH it DEPTH R <br /> DISTANCE To NEAREST WELL R FOUNDATION It PROPERTY LINE It <br /> ❑ SUMPS WIDTH R LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSALPONDS WIDTH R LENSTH If DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTYUNE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY UNE it <br /> !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 4W <br /> OUR <br /> A E U/RE F -PLEASE CALL 209 953-7697/ <br /> SIGNED TITLE Safety Di(wmr DATE�' 7/��� <br /> I " / <br /> I <br /> s e e a t I t a c h e d <br /> E ANT <br /> �r <br /> IR.4L <br /> Nr <br /> J RTMENT E ONLY p A <br /> Application Accepted _� �Z Date 7 Area 3 -/C' Employee ID# A <br /> Final inspection By % -_ Date .J SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of Fh Pius u p Soil Char cter: <br /> COMMENTS O� Q Z <br /> PE SC Received Check#! Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cast Remitted Service Re uest# <br /> Wad ols- 5.Z <br /> 42 31 ONSITE VJASTE4VATER TRTMNT SYSTEM.PEPERMITa'te;ie /W <br />