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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 2275 Bacon Island Orad CITY/ZIP Stockton <br /> CROSS STREET Bacon';land Road APN 12905014 PARCEL SIZE f^l d <br /> OWNER NAME Reclan.ation District 2028 PHONE 510-719-3470 N <br /> OWNER ADDRESS 343 E.Main Street CITY/STATE/ZIP Stockton CA 95202 <br /> CONTRACTOR W.C.Maloney.Inc. PHONE 209-244-7090 <br /> CONTRACTOR ADDRESS Po Bax 30326 CITY/STATEIZIP Stockton Co 95213 <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 /> TYPE OF WORK: NEW INSTALLATION J REPAIR/ADDITION ENGINEER DESIGNED/A TERNATIVE <br /> REPLACEMENI OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION Gln <br /> INSTALLATION WILL SERVE: I= RESIDENCE U COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> O UFTSTATION SIZE TYPE OF PUMP Cl PKO TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION P PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH fl LENGTH It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PCNDS WIDTH If LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMaER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE 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 OUR A NCE E UIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Safety Director DATE ilii ;lzo <br /> s e e a t = a c h e d I IL 1 11111A <br /> RfF7 c MEiyT <br /> AN <br /> F�VF <br /> D <br /> Algz)viN c <br /> �THO P4 74 QTY <br /> 1--±- <br /> DEPARTMENT4J SEONLY < <br /> Application Accepted �-- ate E-/� D . : �2AreaC` Y <br /> L . ! -S I Employee ID# <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/S oil C racter: <br /> COMMENTS /V D� < O✓1 O CBL ✓' Oc✓N1�1./� C� <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# PermitlD# <br /> Code INFOCa h Remitted Service Request# <br /> `%u?;} � J i$ 0 S uZ t �" • lit/ �'� <br /> 42.01 1�F�' J 3�� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />