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L .r <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) 953-76y7 FOR INSPECTIONS EXPIRES T TEAR FRUM LOA It IJJUEI <br />JOB ADDRESS 17000 E Highway 120 -,', j f% 12C „1 c , (-LL' CITY/Z/IP'Ripon �7 <br />CROSS STREET Murphy rd V 4- APN Lt - L' /"-i'ARCEL SIZE <br />OWNER NAME <br />The Wine Group PHONE 209-599-4111 <br />OWNER ADDRESS 17000 E. Highway 120 CITY/STATE/ZIP Ripon CA 95366 <br />CONTRACTOR W.C. Maloney, Inc. PHONE 209-244-7090 <br />CONTRACTOR ADDRESS Po Box 30326 CITYISTATE/ZIP Stockton Ca 95213 <br />LICENSE I ",'C-42 I _'.. IC -36 OTHER C-21, A NUMBER 718243 EXPIRATION DATE 1/31/22 <br />WATER TABLE DEPTH: <br />It GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br /># <br />LAND USE <br />APPLICATION # <br />❑ NERC TEST # <br />BUILDING PERMIT <br />TYPE OF WORK: <br />❑ NEW INSTALLATION <br />REPAIR/ADDITION <br />ENGINEER DESIGNEDIALTERNA E <br />F] REPLACEMENT <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />X DESTRUCTION septic <br />INSTALLATION WILL SERVE: II RESIDENCE <br />II COMMERCIAL <br />I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />i, LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />fl <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ FILTERBED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />fl <br />❑ MOUNDED <br />WIDTH It LENGTH <br />ft <br />DEPTH <br />It <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />fl PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />It FOUNDATION <br />ft PROPERTY LINE <br />It <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 />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />It DEPTH <br />It <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPAREDAPPLICATIONTHE WORK ILL B DONEN ACCORDANCE SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LA RULES SAN COUNTY. <br />HO -""'D <br />FOR INSPECUONS - <br />PLEASE C 0 <br />MINIM <br />�� <br />TITLE Safety Director <br />DATE 2/23/22 <br />SIGNED <br />r✓ <br />T <br />ARTMENT USE ONLY <br />Application Accepted B Date ' 'Y -ZArea Employee ID# ll <br />Final Inspection By Date Z SPECIAL ERMIT -Approved by <br />Character of Soil to DepEh of 3 Ft: Pit/Sump Soil Character: <br />CO�ENTS �L v n N <br />464 4'r <br />�S <br />PE SC Received Check#/ AmountRDate;aj� Invoice # Permit ID# <br />Code INFO ash Remitted <br />42-01 -. A,- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />