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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELTON AVENUE-STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM UATE 1550 JOB ADDRESS 1269 E Grdntline road CIT'/ZIP Tracy ❑ COMMERCIAL A� ("1" 1 CROSS STREET SWard rd APN L!'^� PARCEL SIZE USLP TracyVI LLC Owner OWNER NAME PHONE 2099480302 OWNER ADDRESS 415 Mission Street 451h Floor CITYISTATEIZIP San Francis- 94105 CONTRACTOR W.C. Maloney, Inc. PHONE 209.244-7090 CONTRACTOR ADDRESS PO Box 30326 CITYISTATE/ZIP Stockton Ca 95213 LICENSE I ;C-42 I C-36 OTHER C 21, A NUMBER 718243 EXPIRATION DATE 1131!22 WATER TABLE DEPTH: ❑ PERC TEST # f TYPE OF WORK: ft GEOGRAPHICAL INFORMATION: Coordinates X Y BUILDING PERMIT # LAND USE APPLICATION # –_ NEW INSTALLATION 1EPAIRIADDITON ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION seUll. INSTALLATION WILL SERVE: 11 RESIDENCE ❑ COMMERCIAL !. OTHER LIVING OF LNG UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH R LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL 11 FOUNDATION ft PROPERTY UNE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY UNE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft f ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, [HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE �c MSN T E1 vED C 3 2021 Q joeOuNTY DEP,A TMENT DEPARTMENT USE ONLY _ Application Accepted B l� — L_L Date v 2 / Area / r r-'� l Employee]D# Final Inspection By Date , I FJ SPECIAL PERMIT - Approved by Character of Soil tq Depth of 3 Ft: Pit(Sump So I Character: COMMENTS Ire— ro(" I^ o,r 1 1� S iIC f t7 c, c1, j s Lz v't F0 v PESC Received ChecKv Amount Date Permit' Invoice # Permit ID# Code INFO B Cas Remitted Service R uest # I O iAe4x 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114118