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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 INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 3736 Highway 99 fJ CITY21P Stockton <br />CROSS STREET carpenter rd PN 1 ` L D r PARCEL SIZE <br />OWNER NAME CMAT PHONE 209-470-1489 <br />OWNER ADDRESS PO Box 32314 CITY/STATE/ZIP Stockton CA 95213 <br />CONTRACTOR W.C. Maloney, Inc. PHONE 209-244-7090 <br />CONTRACTOR ADDRESS Po Box 30326 CITY/STATE/ZIP Stockton Ca 95213 <br />LICENSE 1 C-42 � 'C-36 OTHER C-21, A NUMBER 718243 EXPIRATION DATE 1-31-20 <br />WATER TABLE DEPTH: <br />PERC TEST # <br />TYPE OF WORK: <br />it GEOGRAPHICAL INFORMATION: Coordinates X Y <br />BUILDING PERMIT # LAND USE APPLICATION # <br />I NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED /ALTE SATIVE <br />REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM. X DESTRUCTION septic <br />INSTALLATION WILL SERVE: E RESIDENCE <br />❑ COMMERCIAL <br />1 OTHER <br />NUMBER OF LIVING <br />UNITS: NUMBER OF BEDROOMS: <br />O—IMPLOYEES: <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 />LIFTSTATION <br />SIZE TYPE OF PUMP <br />❑ PKGTXPLANT ❑ <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 />fl PROPERTY LINE <br />fl <br />❑ <br />FILTER BED <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 />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 />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS 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 />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 />I HEREBY CERTIFY THA AVE PREP ED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />/f�t� STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINI <br />A FY AdJ[dAfrF NAT1rF RF()11/RFA <br />FAR INCPFrT1ANC - PI FG SF rAl I /9D01 9.57 7RQ7 i <br />SIGNED <br />TITLE Safety Director DA <br />Application Accepted B LA Z Date 7 Area <br />Final Inspection By A Date f LL 11 S <br />Character of Soil to Dept of 3 Ft: Pit/Sump Soil Characl <br />COMMENTS cll <br />Se VP -,A Cj 1^%r A0 Iry <br />y <br />C <br />lv)- <br />/4-,( Employee ID# '7k 6q <br />PERMIT -Approved by <br />PE Sc Received Check#/ Amount Date Permit/ Invoice # Permit ID# <br />Code INFO By Cash Remitted Service Re uest # <br />)09*109 <br />4/14/ : I 2[/' /y/' �Qq ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114118 J_`�'1-I/V1 <br />