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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 PERMI CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11 ornton Road 0 b� (�/ j'0 0L9-/- CITY/ZIP Lodi, CA 95242 <br /> M, <br /> CROSS STREET Davis Road ApN 029-020-02 PARCEL SIZE 45.5 0 <br /> 0 <br /> OWNER NAME California Wine Classics LLC, Leslie Boudoff PHONE 209-365-4664 <br /> OWNER ADDRESS 27 East Locust Street CITY/STATE/ZIP Lodi, CA 95240 <br /> CONTRACTOR TERRACON CONSULTANTS INC PHONE 209-367-3701 <br /> CONTRACTOR ADDRESS 902 INDUSTRIAL WAY CITY/STATE/ZIP LODI CA 95240 <br /> LICENSE C-42 C-36 OTHER C-57 NUMBER 669004 EXPIRATION DATE 5/31/19 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> X PERC TEST # 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 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 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 WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft 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 MAYft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER TY$ ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH E —QU/ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY MFNV7-y ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH � MFNT ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> MINIMUM 48 HOUR <br /> A/DVAN E NOTJCE REQUIRED FOR INSPECTIONS -PLEASE CALL 2 953-7697 <br /> SIGNED J� u �� TITLE STAFF SCIENTIST DATE 05/14/2019 <br /> ............... <br /> , <br /> 17-1 <br /> ----- ........... <br /> i <br /> EPARTMENTU E 01NLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date — SPEC AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: i Sump Soil Character: <br /> COMMENTS Re rC <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />