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} <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1669 S Main Street CrTV/LP Manteca 95336 <br /> CROSS STREET E Woodward Avenue APN Ot a LJ Da PARCEL SIZE <br /> OWNER NAME Marketplace Q Main,LLC PHONE 209-533-3333 <br /> OWNER ADDRESS 133 Old Wants Ferry Road-Suite G CITY/STATE/ZIP Sonora 95370 <br /> CONTRACTOR Modesto Sand and Gravel.Inc. PHONE 209-545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STAT1I Modesto,Ca 95358 <br /> LICENSE C-42 C-36 OTHER C-12 C-21 NUMBER 271166 E%PIRA TION DATE 02/28/2023 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # I I BUILDING PERMIT* LAND USE APPLICATION* <br /> TYPE OF WORK: NEW INSTALLATION REPMR/ADDITION ENGINEER DESIGNED(ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION SeptlCTank <br /> INSTALLATION WILL SERVE: RESIDENCE 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 /> DISTANM W INAMBI WELLR FouNCATION ft PROPERTY LINE II <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKO TX PLANT Q SAND OILSEPARATOR(ENpASED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS *OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION III PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE it <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE Il <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIotH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft <br /> L1 SEEPAGE PITS NUMBER WIDTH it DEPTH Il <br /> DISTANCE To NEAREST WELL It FCUNOATION ft PROPERTY UNE It <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE(ANS pND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> N09 NOTICE REQUIRED F 2v <br /> SIGNED TITLE Project Manager DATE <br /> cF,�or <br /> DEPARTMENT.USE ONLY <br /> Application Accepted By ate Area C 1 lmTEmployee ID# LC�Q ?022 <br /> Final Inspection By Date L t..� ! SPECIAL PERMIT-Ap <br /> - proved by R h CD <br /> Character of Soil to Depth of 3 Ft: PAISump Soil Character: pe F/VTd'vry <br /> COMMENTS J" F �� �P �PI✓1�1i�'7CC� 'rTTMFrCN <br /> T <br /> PE SC Received hec Amount to Permit/ Invoice# Permit ION <br /> Code INFO By ash Remitted Service R ues <br /> L- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4,14;18 <br />