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APPLICATION FOR U4UIO WASTE PERMIT <br /> SAN JOAGIUM COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKFON•CA 45202 <br /> p (209)488-3420 <br /> S D'�p-�} NON SEFUIfO�IiLE rcrrlT FlEnREf 1 YEA%,,GN 9AII 133V <br /> Yb b TriP9A IST TION M NAGE M COMPLIANCE WTTN SM <br /> FOR A PENAIT TO CONfF1tICT^"DOOR SISTAtl THE m HE OEICJWED-THIS APPLICATION/1L HEALTH DI[MION. <br /> APPLICATION M NBIESV MAGE TO lliF DAN.IOAOIAN COtHRY IJEALIA StlINICll fl/1N �I <br /> JOAOUN COI D"LOPLIENT TITLE.C�*LAPTE 179- 110.1/UO THE iFA1DA1�Of WI JOAOUiN COUNT'WrIIC /Y <br /> 1' [ /� ( � G�. LOT.vE <br /> JOY ADOwE66lON ARIL_ Tl R�L,% PHONE_ <br /> owNERe NAraF� p �J .5 9.s 43-,.Z FNDNE�S SSS <br /> l Fy�l /�- <br /> ADOIESS,� <br /> CONTMCTOw IICi PHONE <br /> ADDRESS <br /> SVS CONTIIACTOR ALLATION IN REIIIWADOrnoN❑ 011111TAI N 13 <br /> TYPE OF SEPTIC WORIL "m UNIT P/1C 7rSTM E 1 NINN AtANT <br /> SA]EERK 6'VSTEM PUSRTTAD If PI Sl3A'ER to AVASAStE WITIIN 700 FEET OF SINLONO.1 A�eESSA! <br /> INSTALLATION WILL SBIYE: lESIOENCE Is cDMMOKtAI <br /> [] OTHER❑ <br /> oP rmRODUE:�.,,NIrAEet a EHFIorEEr: - <br /> "twimm OF Lm"UISTS:�/INNS 1TA11IM WATER TAKE OFOTH <br /> PSILL CHAA11 � <br /> CHARACTER Of iOr TO A OE/TN OfT7��0._---�J` CAI I:,l <br /> tTY NO.COIYAREMFNEB 2 <br /> SIiTM TANXJor&ASS TRAP L•/ r./• Po uI I'S PROPERTY ESE�J~ <br /> KO ilEA7MOIT BANE❑ SISTASICE M NSAMSd: Wgl OIL i[PAAAJ OR(ENCLOSED SYVFW) <br /> SIM <br /> E Tvm 43Fruw SAND <br /> �^• �^ T V pBT/1NCE TO NEAAF/f:WELLlfL•�•_FOUI�� ��,I,,�UIaE <br /> LAACNNO UHE d NO.A LENOTN OP[AIEB FOUNDATION <br /> lD1OTH 09TH pfITANCE TO IIEA/E1ET:WELL <br /> FILTR SFD O UIIDTH FOUNDATION MWPERTY LINE <br /> ❑tNIDTN tENOTH DWr" DISTANCE TD NU,11l ST:INCL! PFOFERTy LINE <br /> ApWOEp FDIRQA7IDN <br /> ❑DEPTH S= NIS1rSR grTANCE TO NEAREST:WELL UNE .� Fyf <br /> *taws PLti / DWAM CE TO NEARESE:y,E,,[�j�F TFMIIIOiAt/ON• Z_ <br /> Q, H ' {EN6TH�.D�H� pTpPEATY IfNF <br /> Slki DEPTH piTANOE TO NEAREST:WFL1 P011IOATtON <br /> aSPOaAI FONDS ❑WIDTH tENMTH <br /> APPLICATION AND THAT THE WOW TVAL K DON!N ACOORDANCE WTT/I SAN J CpffW COIIN IN <br /> M PFF NOES ALIO STATE WO S,AND PLAES <br /> ASENE'S NONATUEE CV IEtI TH[FOLLOdFilio7CJifTMYTNASI NTIIE PEIPOIRLANCEOf TNAWOO[TORWNCH <br /> 1 HERESY C ATIO.-NAT 1 HAVE I MIAMI" <br /> iMi PERSON <br /> SUCH LICENSED COSS'a" N UilAli OF CAAIPOMAA-'COMRACTOR'S I ISSFID OR <br /> ALIO IEOUlAT7OM OP l-E MN JOAO[OI COIA'ITY. RAT AS TO S[CDME SIIS.OF T TD tAIOEKAOR W <br /> THIS PI M togim t MAIL NOT 2111 ANT FFIMON N C SS W TINE P@/OERSM'IC!OF <br /> THE WOIK P0111MSCN TIM P9 O MSUED.1 MSALL ETIROY PEMOW SULIECT TO <br /> SUS-COWKWTNIO MORAT'"WffMS THE FILL VWM CALL 24 IIOUM IN AV ICI FOR ALL RSOI/I SYPR TtOei•CoMKM DRAT�I- I� <br /> IAtOIi{MAM•S COLVILIMATION LAWS OF CAL.00 -�THE <br /> APLLCAM SINST <br /> //iJi'�//IZ' DATE- <br /> ./I <br /> /y '� I/f TITLE: t <br /> MOIITD I �i/ <br /> PLD,PLAN gXI TO SCALP SCALE <br /> 4.LaATICK OF ROME SEIISA[E omrosAL SVSTEm OR FROI <br /> 1.HAVES OF STIEET71 OR ROADS I EAPIM TO OR soumw S TSE marawy. vrAN M OF SYRSNL VISP L SYSTEM& J <br /> Y.O ST <br /> VRNE OF 7HE F1IOPERfY. DNINMIONS AND NOW"OSECTNN- i.LOCATION OF WELLS VATHN NORM OF OONE"U NOTED FM1TY FT.oN <br /> 7,tSMlNMONEO OUTLINES AND LOCATION OF ALL F)GS7M JUID PIIOFOfEO NK RMS• .....TIE FIVP6EEYOR ADEDNRND PLIOPEHEY• <br /> NCWpNO COMPED AMM SUCH AS PATIOS.pOYELYAY4 AMS WILLIES. <br /> .. - - ....-.E. <br /> .......- ._ i _ ..... <br /> .. . ..a .. .. ..... ....... «».......... <br /> ..-.......: _ ... ..._.0 <br /> :.. i.. ....:.......... V ...................... _ .--_.... <br /> OC <br /> _ <br /> ........ . <br /> L' 1 <br /> _.._._ ..._......__._... . ._.: _..._.._.__ bAI _... <br /> __ <br /> t.. . ..:.... .... . . <br /> NVIROE <br /> fiEAETH S MLtENTAL <br /> _.. ...__...... ............ Eftcis i.. <br /> ....... <br /> FOR OeP&II NT USE O/KT <br /> DATE: <br /> APPLICATION ACCEPTED BY Ag� l <br /> Alf ! / FINAL INSPECTION 0 Olr I G <br /> TAN(,FIT IM SUMP NSPECTIO1 _ <br /> AOIXIIONAL COMMENEo: Gl r,•v <br /> ACCOIA17MD OTgY: AIDS FACS <br /> p"coot*IRAMOLMd I@EtT>MKt/CASN Aww4w SY OAT! M/PYORf �. <br /> Pub.HPIWh SON -Ewro.174(319 <br />