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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 /> Jos ADDRESS 2275 Bacon Island road(GPS 37.9458C6,-121.535506) CITYIZIP Stockton w <br /> H <br /> CROSS STREET Bacon Island Road APN 12905014 PARCEL SIZE p <br /> 0 <br /> Metro Water Dlstdcl Of Southern Ca 510-719-3470 m <br /> OWNER NAME PHONE <br /> OWNER ADDRESS PO Box 54153 CITYISTATEIZlp Los Angeles 90054 <br /> CONTRACTOR W.C.Maloney,Inc. PHONE 209-244-7090 <br /> CONTRACTOR ADDRESS Po Box 30326 CITYISTATEMP Stockton Ca 95213 <br /> LICENSE -,1F C-42 FI-C-36 OTHER C-21,A NUMBER 718243 EXPIRATION DATE 1-31-22 <br /> WATER TABLE DEPTH: A GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L) PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L: NEW INSTALLATION J REPAIRIADDITION ENGINEER DESIGNED(ALTERNATIVE <br /> G REPLACEMENT J OUT-OF-SERNCE SEPTIC SYSTEM X DESTRUCTION soPliC lank <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE D COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE 11 <br /> ❑ LI FT STATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION 11 PROPERTY LINE 11 <br /> ❑ FILTER BED WIDTH it LENGTH it DEPTH tt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE it <br /> ❑ MOUNDED WIDTH It LENGTH it DEPTH fl <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> Q SUMPS WIDTH if LENGTH ft DEPTH if <br /> DISTANCE TO NEAREST WELL it FOUNDATION If PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUI6BER WIDTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> [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 /> MINIMUM 48 AQU9,116VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 20 9.5-3-769 <br /> SIGNED TITLE Safety Director DATE 118121 <br /> S e e alt t a c h e d <br /> PAYMENT <br /> RECEIVED <br /> JAN 1 1 2021 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> I I <br /> I I I <br /> DEPARTMENT USE ONLY /1 <br /> ✓ I ' 7��Cv <br /> Application Accepted 6 1� / Date ,'> J I Area - Employee ID# <br /> Final Inspection By Date 2," 7uL1 ❑ SPECIAL PERMIT-Approved by <br /> Character of Sail to Depth of 3'Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Rece've Lit Amount Date PermiU Invoice# Permit ID# <br /> Code INFO Cash Remitted Service Re ues # <br /> 4sJ + 75 l3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />