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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 CITY/Zip Manteca 95336 <br /> CROSS STREET E Woodward Avenue APN 19 O LI 012 3 PARCEL SIZE L' <br /> 0 <br /> 0 <br /> OWNER NAME Marketplace @ Main,LLC PHONE 209-533-3333 <br /> OWNER ADDRESS 133 Old Wards Ferry Road-Suite G CITY/STATE/LP Sonora 95370 <br /> CONTRACTOR Modesto Sand and Gravel,Inc. PHONE 203545-4425 <br /> CONTRACTOR ADDRESS 6137 Hammett Ct CITY/STATE/LP Modesto,Ca 95358 <br /> LICENSE D-C-42 L.-C36 OTHER C-12 C-21 NUMBER 271166 EXPIRATION DATE 02/2812023 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION -. REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION Septic Tank <br /> INSTALLATION WILL SERVE: G RESIDENCE L COMMERCIAL LOTHER <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 /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <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 ND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209195A76971 <br /> SIGNED TITLE Project Manager DATE <br /> pgyMF <br /> R y O <br /> DEPARTMENT.US NLY �Q�? <br /> 3 C ��Y4�Employee ID# � O <br /> Application Accepted By Date 7 Area � <br /> Final Inspection By I Date L ❑ SPECIAL PERMIT-Approved by NM Coil, <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: �i�r{{�r�EPTh'7 <br /> COMMENTS HOC11` 4p JoP <br /> -WR n,Ls e0l Re <br /> PE SC Received hoc Amount1e Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service R ues <br /> < G__ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />