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�- 0-5 -�IS 7 %/ ?zi RI, 5-6 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468.3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR I <br />JOB ADDRESSi 2'��• L���f S II �•V '7 <br />CROSS STREET Bacon Island Road API,�I Z <br />OWNER NAME f Reclamation District 2028 / ` 2" �Cr y L'-1J..C!- y <br />OWNER ADDRESS 343 E. Main Street <br />rnmr rvna W.C. Maloney, Inc. <br />CONTRACTOR ADDRESS Po Box 30326 <br />LICENSE UDC -42 ❑DCi-36 OTHER C -21•A NUMBER 718243 <br />CITY/ZIP Stockton <br />-L'5 I <br />MAPIKt5 T TtAK <br />PARCEL SIZE V �` <br />510-719-3470 <br />rY/STATEIZIP Stockton CA 95202 <br />PHONE 209-244-7090 <br />CITY/STATE/ZIP Stockton Ca 95213 <br />EXPIRATION DATE 1-31-22 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ <br />PERC TEST # <br />BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />' REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />X DESTRUCTION Tj <br />INSTALLATION WILL SERVE: 17 RESIDENCE <br />I I COMMERCIAL <br />I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE To NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ <br />LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE To NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />f1 FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />MOUNDED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />It <br />DISTANCE To NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ <br />DISPOSAL PONDS WIDTH fl LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />I HEREBY <br />CERTIFY <br />/ STATEA-AWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />SIGNED <br />Application Accepted <br />Final Inspection By_ <br />Character of Soil ++to� 0 <br />H <br />COMMENTS C <br />717J�1W►C•�1�7�F73�1�7ci�t/trra�ri <br />Safety Director DATE <br />DEPARTMENT USEO Lj <br />/ Date Area Orl el Employee ID# <br />ter C Date 2 1 ' SPECIAL PERMIT - Approved by <br />pth of 3 Ft: Pit/Sump Soil Charact r. <br />C ,�fa ck� , Lig i DC <br />Nd•, <br />COQ <br />NTgt <br />4f NT <br />4 p n I �j ^ 1-1 C52 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/141114/ 18 11 i� /L"' <br />