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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 • (209) 466-9420 <br />NON-REFUNDABLE PERMIT CAI /209) 953-7697 FOR 1NSPE MONS hXPIRES l YEAR FROM DATE 155UEI <br />JOB ADDRESS 2275 Dawn Isbnd road (GPS J . 116664j' —/j Zp R-kton } <br />CROSS STREET 83rn Island Raid APN 12905014 PARCEL SIZE 1 71 <br />OWNER NAME Melm Yater District Of Southern C■ PHONE 51D•719-3470 <br />OWNERADORE33 P080x54153 CITYISTATEIZP Los Angetas9D05A <br />CONTRACTOR W.C. Mabry, Inc. PHONE 209-244.7D90 <br />CONTRACTOR ADDRESS PO Box 3032G CITYISTATEMP SU Ckton Ca 95213 <br />LICENSE :-Ir C42 n -C-36 OTHER C -21.A NUMBER 718243 EXPIRATION DATE 1.31.22 <br />WATER TADLE DEPTH: <br />if GEOGRAPHICAL INFORMATION: Coordinates X Y <br />U PERC TEST # <br />BUILDING PERMIT# <br />LENGTH OF UNEs ft <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />_ NEW INSTALLATION U <br />REPAIRMADDInON <br />ENGINEER DESIGNED/ALTERNATIVE <br />R PROPERTY LINE it <br />J REPLACEMENT D <br />OUT-0FSERVICESEP7IC SYSTEM X DESTRUCTION septklank <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />'L OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPERAFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPEIMFG <br />CAPACITY <br />gal #OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />N PROPERTY LINE R <br />❑ LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKOTXPLANT <br />D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />� LEACHING CHAMBERS <br /># OF LINE$ <br />LENGTH OF UNEs ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />R PROPERTY LINE it <br />❑ FILTER BED <br />WIDTH <br />it LENGTH <br />it <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />it PROPERTY LINE It <br />❑ MOUNDED <br />WIDTH <br />R LENGTH <br />R <br />DEPTH N <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />fl PROPERTY LINE it <br />❑ SUMPS <br />WIDTH <br />it LENGTH <br />R <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNDATION <br />it PROPERTY LINE It <br />❑ DISPOSALPONDS <br />WIDTH <br />It LENGTH <br />ft <br />DEPTH it <br />DISTANCE TO NEAREST <br />WELL <br />it FOUNOATION <br />R PROPERTYLINE it <br />❑ SEEPAGE PITS <br />NUMDER <br />WIDTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />A FOUNDATION <br />It PROPERTY LINE it <br />I 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 />TITLE Safety Director DATE _ <br />RE yMFNT <br />CES VED <br />SEP ? 3 221 <br />In _ <br />ti 0NMFC0�NTY <br />DEpgRT��NT <br />DEPARTMENT;USEIONL Y I <br />Application Accepted DateArea -`° r Employee IDN <br />Final Inspoction By Date 1 J ❑ SPECIAL PERMIT •Approved by <br />Character of Soil to Depth o(3 -R, PiUSump Soil Character. <br />I <br />COMMENTS �l?G� I.� li 'v,try I V ,1 I, YIZ <br />PE SC I Received ICh6CkwI Amount Permit/ Invoice # Permit ID# <br />-•- pate . ' -�--..__.« <br />42,01_ / � ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />� <br />4114118 / jam! l3 / 7, S Y: �)2-,-)- <br />DEPARTMENT 1jSEjONL <br />z.z-_ <br />