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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRON"EINTAL HEALTH DEPARTMENT 1866 E.HAZELTGN AVENUE-STOCK70N CA 95205-(209)468.1420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS <br /> 260S South MnUVTur Odw CITYIZJP 7rncy 85377 <br /> PARCEL SZE <br /> CROSSS7REET APN2C6-t4A2J er/ <br /> C <br /> F <br /> OWNER NAME VsIpIco Tracy Apadmoru LLC PHONE 2094A9-1299 <br /> OWNEA ADDRESS 2494 San HIII rDad it00 C—ISTA7EfZO <br /> CONTRAC70R W.C.Moloney,Inc. PHONE 209-244.7090 9 <br /> CONTIUCTOI7 ACDRESe POS-30326 CITYISTATEMI Stockton Ca 95213 <br /> LICEN3e DIC-42 D-IC-36 OTHER C-21•A NUMBER 718243 EXPIRATION DATE I13122 <br /> WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERCTEST k BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L. NEw INSTALLATION u REPAWADDIT1oN L ENaWEERDEBI0NE01AL;ERNATIVE <br /> G REPLACEMENT 7 OUT-OF-SERVICE SEPTIC SYS7EIA ',X DESTRUCTION Seyr_ <br /> INSTALLATION WILL SERVE: G RESIDENCE O COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER of EMPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal k OF COMPARTMENTS <br /> O GREASETRAP T'tpElMFG CAPACITY gal k OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION R PROPERTY LIN= R <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAN D OILS EPA RATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACIIINGCHAMBERS` `#OF LINES LENGTH OF LINES R <br /> DISTANCE TO NEAREST VIELL R FOUNDATION fl PROPERrYUNE 0 <br /> ❑ FILTER BED wo7N fl LENGTH It DEPTH M <br /> DISTANCE TO NEAREST WELLIt FOUNDATION It PROPERT'ILINE R <br /> ❑ MOUNDED WIDTH R LENGTH R DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R pROPERTY UNE R <br /> ❑ SUMPS WWTH R LENGTH It DEPTH R <br /> DISTANCE To NEAREST %VEIL R FOUNDATION R PROPERTY ONE It <br /> ❑ DISPOSALPONOS WIDTH It LENGTH It DEPTH R <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LUNE R <br /> ❑ SEEPAGE PITS NUN9ER WIDTH It DEPTH 11 <br /> DISTANCE TO NEAREST WELLIt FOUNDATION R PROPERTYLINE h <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 REOULA710HO OF SAN JOAQUIN COUNTY, <br /> INI R D FOR INSPECLONS-PLEASE CAL 7 <br /> SIGNED TITLE Safety D"Dactor DATE— <br /> S e e a c L a c h e d m a p <br /> ECE FN l <br /> R 10 2021 <br /> Qu/N C <br /> p4RT74t <br /> D E PAR T M E NT E SONLY h� <br /> Appllcallon Accepted By �L z— Date � _ Area i� Employee lDA 1J <br /> s / 1 ' <br /> Final Inspection By L� ;r--N Dale 1`L�Lf� 0 SPECIAL PER IT.Appmvod by <br /> Character of Sol]to Depth of 3 Ft: IVSu P Soll Charatler: <br /> COVMENTS SF,ofR i:' Co <br /> uc4'JI}inn tD SQ��231yN . <br /> PE SC Received Checkkl Amount ate Pefrn Involce NT Permit ID: <br /> Code INFO Cu Romltlad <br /> -7-5- <br /> Se Ice Ra est k <br /> PEE <br /> 42-01 / 1 42-0112 <br /> /`� 2— 1 ONSITE WASTEWATER TAT MNT SYSTEMPERI.HT <br />