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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 1150 N.P%mtyn-Road DIY vi e-;- gots,} CITY/ZIP Lodi,CA 95242 v <br /> r� <br /> CROSS STREET Davis Road APN 029-020-02 PARCEL SIzE 45.5 <br /> O <br /> OWNER NAME California Wine Classics LLC,Leslie Boudoff PHONE 209-365-4664 <br /> OWNER ADDRESS 27 East Locust Street CITY/STATEIZIP Lodi,CA 95240 <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITYISTATE/Z1P LODI CA 95240 <br /> LICENSE 01-C-42 01-C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION - REPAIRIADDITION '.7 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM n DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 'D 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 /> DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH_ _ ft LENGTH it DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINEft <br /> [�� <br /> ❑ MOUNDED WIDTH ft LENGTH R DEPTH _y it <br /> DISTANCE To NEAREST WELL ft FOUNDATION it PROPERTY LINE �4 ft <br /> ❑ SUMPS WIDTH It LENGTH It DEPTHA. 4 . it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ff PROPERT11w 'j-_ ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH fl OEPTHDUft <br /> _ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY r Mffyla�TM R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH T�ENJ ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <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 AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> y� E CALL <br /> (209)953-769 <br /> SIGNED // TITLE STAFF SCIENTIST DATE 05/14/2019 <br /> �®1 <br /> j 1 <br /> / gE P A R T M E N T U4 E CVNLY <br /> Application Accepted By Date Areal Employee ID# � <br /> Final Inspection By Date_ L SPEC ACL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PltlSump Soil Character: <br /> COMMENTS <br /> PE Sc Received Ch Amount Permit/ Invoice# Permit IDS <br /> Code INFO B Date Cash Remitted Service Request# <br /> 4ZZL <br /> 15,14 MmdGl <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br />