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APPLICATION FOR LIOUIO WASTE PERMIT <br /> FF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENWRONNUENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 N.SAN JOAUUIN ST,STOCKTON,CA 86201-0381 <br /> 1 (208)488.3420 <br /> F _ - <br /> 1110M- EPURRASLE PERMIT EXPIRES 1 TTAILFROR DATE 111113 ! <br /> I('4XWkM TB TripRa4la) I( <br /> AIRFMATION IB HERESY MADE TO THE SAN JOAQUIN COUNTY FOR A FERMIr TO CONSTRUCT ANU/ON INSTALL THE WORK DESCIFBED.THIS APPLICATION LOMAD[MR COMPUANCE WITH SAI% <br /> JOAOUN totwv OEUADE mmr TfTLE,CHAPTER 9-1110.3 AND THE STANIMM OF BAN JOAQUIN COUNTY ruSuC HFALTx RFJTVI M ENvNONMENTAL IEALTH 01Amm. <br /> I <br /> JOB AOOK SBIOR APNIP)68rit 1374FIVAlf~ rTQ• CRY jOAC A Z4-oy IAT SVE <br /> T OWNen•sNja.'&J IL/&do--f�JJ�40/V_ADDRESS e - <br /> ;1oNE <br /> cDNENAcrorL ii`1F'iRio� 50ir ADd1ESe ri�ex 14 Lo�Q1� L-Jefe+ll rd uc,r flow-or/ FHON�w f <br /> eCONTRACTOR �E AUPI�SS LICP p"w; a <br /> TTWP-oP sEST1c WewL: MEW M ITAILATION 101 1®AMHlAODITION 13 ODLTTSICTgN Q <br />• LAID SEPTI.9YBTEM IERLETTED M'PLIC HEWER la AVA0.ABLE YJRMN$OOFFFTOF BUILDSIOJ PEIC TGSTIO I IN"11V116Y <br /> �E <br /> IAppil.016.R <br /> IL <br /> Np6TAARON MILLSMO@ REODENCE E3 COMMEHCIAL 0 OTHER 13 MO4 DrA-++F1' f -VA90 g 17 ?SD 'pr <br /> NUMBER OF LMOO UMTS, NUW MI aR MmIIDOMN> Y MIYWER OF EAKOYE®: <br /> CHARACTER OF SOIL TO A DEPTH OF 2 FEET._ fj/4d-_ riumu IP SOFL CHARACTER.- WATER TABLE Dan+ <br /> 9Elflc TAJMUf•EASE TDAr 0 VlVMMFD piI C0rf7' pQ cAPACRY /XLV o NO.COMPARTMENTS ;3' <br />'f PTLD iREA7MENT nANT 13 ARANCE TO REARESt: ---ke roDNDAnoN /[r` ;gPERTY UNEP/OO` <br /> r TFT eTA710N❑ SIZE TYPT Or;MIP aAND OR SEPARATOR IENOHDBEO SYSTEM) <br /> LENDTN O ; <br /> IiACMNG ENE NO.A F UNED3- a0� OHMTANCE TO NEANEDT:WELL TEM` FOUNDATION Fr' PROAFIIIYHJNE 6&' <br /> rwrm BED I3 WIDTH L mnO DwrH DISTANCE TO NEAREST:W LLQ_FOUNDATION PROPERTY LINE <br /> "mumom OwMTnI LENGTH owrH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY I1WE <br /> C 6@ASE INTO 13 DEPTH SCE NUMBER OMTANCE TO NEAREST:WELLFOIMHOATTON PROPEKIV LrW <br /> SWFG 11 WIDTH LENGTH owm DI9rANCETO W-OMOT:WELLFOUNOATM PPIDPERTYLW n, <br /> DISPOSAL MMW 13 WIDTH HEN0Tx OEF N DISTANCE TO S,EAIIE61`i WELL FOUNDATM POOP&MUNE Lrr4l' <br /> I HEREBY CFRINY THAT 1 HAVE PAWPARED THIS APPUCATIDN ANO TNAT THE V.g1TK WILL BE DONE NH ACCORDANCE WITH SAH JOAOUIN COUNTY OROMYANCES AND STATE LAWS,AND RULER LO <br /> ANO ROMULATIONR Or THEBAN JOAOUWCOUNTY,HOME CMNER OAUCENSEOAaVWrS SMNATVRE CERTIFIFSTHEFOLLOYMO:'ICEnr THATNITHEPEFWIDMANCEQFTNE WORE FORWIMCH r$ <br /> TNS FERNMT IQ MOLEO,I OHALL NOT rMKOV ANY FT:ROON BI MUCH A MANNER AS TO BECOME SUBJECT TO WOrILMANB COMMENRATgN LAWS OF cAUFORMA.' CONTRACTOWS HWNO OR <br /> BIDS-OOWFLACTINO WMAT WE CERTIFIES THE FOLLOWNOI'1 CIONMYTHAT M THE PEEDOWAANGE OF THE WORK FOR W)WH TNI9 PERMIT IB MSUM.I WALL E%WWY PEROD"SUBJECT TO <br /> + WORKMAN'S COMPENSATION LAWS OF CA'UMMA.- THE APPUCIWT MUST CALL 24 HOURS IN ADVANOR FOR ALL REOIAAED INBrEcTgRF-COMRETE DRAWING BELOW. <br /> EARNED x �LfJ'4�//'•�J.- �__ TfTLE: DATE,It/ <br /> ' �-9 <br /> PIAT PLAN IDRAW TO BCALEi SCALE <br /> 1.NAWO OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. 4,LOCATION OF HOUSE SEWAGE DMFOSAL SYSTEM OR PROMM <br /> Z.OU'rLoa OF THE PROPERTY WITH DIMENSIONS AND NORTH DIREOTION. ERPANBIPN OF SEWAGE M6FOBAL 9Y9rEAB. <br /> J A DwrtNmpH1ED OLlTLME9 AND LOCATION OF ALL EJG6nN8 AND FROPOMEO STRUCTURES, B.LOCATION OF WELLS WITHIN RADIUS tN'ONE lR1IIORm FIFTY FT,ON <br /> INCLUDINO COVB D APEAB SUCH AS PAT 06,DRIVEWAYS.AND WALKD. THE PROPERT OR ADJOINING NKH E . <br /> AFr <br /> 1.1995 <br /> DEC <br /> Fit <br /> ..... ..... ........ <br /> �. <br /> ..,.,. _ <br /> r <br /> IQ4 r <br /> �N411� RIE,sI to�. <br /> Jst7r�`vTr1��:RL14;f3 <br /> 1 ... .. ..,...,,.. ..., <br /> v <br /> tp <br /> ...... <br /> . MadHuGEer �°��� <br /> j ....... . <br /> :.. . <br /> ,off ... .... <br /> ........ <br /> ' FOR DEPMTMMT LYE ONLY <br /> C APPLICATION ACCEI'rM BY c P. DATE: Z AFfA-' <br /> TANK,PIT OR dump V48KCMN BY DATE 1 1 FINAL INSPECTION ON <br /> I <br /> ADDITIONAL COMMENTS: <br /> ACCOwflNO ONLY: AID/ FACT <br /> 4 Pe LVOE Fil)FFD ATAOW r REMHTTBD cNBc Mex RECEVm BY MATE ew/FEeISr NyIBEI INY'ON'E i , <br /> r 1202 <br /> 1 <br />+ J <br /> f �I <br /> iL <br />