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APPLICATION FOR LIQUID WnFERMIT <br /> �- ( 1 SAN JOAQUIN CQUNIY�U EA11.Tk1 SER1lIES , r °::; � 5 <br /> 'ENVIA NM NTALH E. F� IVISI01.,' <br /> 304 EAST WEBER AVENUE,STOCKTgN,P CrA,9S2p2_ <br /> (209)468.3420 <br /> NOIFEEFUNPARLE PERNUT E)LPIRES 1'YEAR FROM DATE ISSUED <br /> �FAINUP1BEE�c.7,iPRwN) sc J <br /> F AP7.ICATMN IS HETFBY MAGE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTI1VCt AND/OR DIaIALL THE WORK DESCPISED.THIS APPLICATION IS MADE ANIPUA N <br /> JOAOUIN COUNTY DEVEWPPA'E]NTJTITLLEE�.CHAPTER 9-11 t0.3{/AHD THE B/T)AINOARb•s or SAN joApUM couNry PUBLIC HEµTN S,E��Rft AcfA ENNRomNXNtAL HEALTH DIVISION, <br /> JOS ADDRE99MR ATN, V� J- Ir.l P`.O Off G/I�'. _ CITY 'L d LOT/BARE ek•W4 7`' <br /> GWNER'S NAMFM�7F]./J��,�-•Jt � �-+ � �/ X17 PHONE <br /> " GOHTRACTOR�dI�'VA) Zv C_ ADOREA6 ILI I" C�' ^*-'�L�L{ `GT. �f` LIC,� 4-L �PHONE .'.L"�tD <br /> BUB CONI/V1CtOR ADORE66 UC, P10NF J <br /> TYPE OF Ear=WORPL- NEW DISTALLATION a IL�ABUAODITN/N OTSYIRM:'riOR I] <br /> DID SEPITC BYSTM PERMTREO IF PUBLIC SEWER 18 AVAP ASM%MTMH 200 FEET OF BIRIXHG.f PESRC TESTDf 1!MOW MARY <br /> A,p9aSden, <br /> IMStMLRTFON WILL sDIVE_ sevo NCEW COMNfD mAL 13 OTHER <br /> ROMRLR OF LIVING UMTS_ NUMS6t OF iEDNODMF: NUMEM OF FMPLOYMB: <br /> CHARACTER OF WtL TO A DEPTH OF�AT FEET '2 TlSUMP BOfL CNARACTFII:I�WATER TABLE OEFTH Z00 f <br /> SFTTO TANBMIEASE TNAP 0 TYpEmF4ii_CAPACITY NO.COMFARTMENTB <br /> PKG TREATMENT PLANT CI INSTANCE TO NEAREST: WELL FOUNOATIOH PROPERTY LINE <br /> LIFT STATIOIL©,�SIyZE_ TYPE OF PIMP``'' l BARD OR SEPARATOR MNCLOSEO BYBTEMI <br /> LEACIQIO'LNIE ;RL NO.A LENGTH OFLINE6 I-7D" lr'r� IXETANCE TO REARERT_WEl4�FOUNDATION 0040 d `.PROPERTY LINE <br /> FILTER SED ❑WUM LENGTH OEPTH DISTANCE TO NF.AREBt:WELL. FOUNDATION PROPERTY LINE <br /> MOHNDED WIDTH LEHOTH DEPTH y DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LINE <br /> SAGE PTS OEPrH ] ' S2E �4 NUMaER_.3;_...,,�OtatANCE TO HFARWt WELL U�'f` FOUNOATWN PROPERTY LINE iib <br /> SIAKPS 3 VVR LENGTH OFPTH DISTANCE TO NEAREST:WELL��FOUNOATIOk i PINE <br /> OMPOM PONOS El WIOTH LENGTH DEPTH DISTANCE TO NEA ESTI NEIL FGRRNOATMN PROPERTY L*IE <br /> 1 HEREBY CERTIFY THAT 1 NAVE PREPARED THIS APPLICAT N AND THAT THE WOTK NSE.Ot DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY ORINNANCES'AN D STATE LAWS,AND RULES <br /> AND RFDULAYwNszF.THEsM JOAOIRN.COUNTV..HOME OR LICENBED AOEW4 SIGNATURE CERTIFIES THE POUDVANG:'ICERTIPYTHAT IN THE PERFONNAHCE Of THEWOlFLfORV4W_4 <br /> THIS PERMIT ALL EMPLOY ANY PER SUCH A MANNER AB TO SEOOME SUBJECT TO WOPIMAN'9 COMPENSATION LAWS OF CALK OMA.'CONTRACTOR'a HITSNO OR <br /> SUR-00 A RE THE FOLLOM : CERTIFY THAT IN THE PBRIVRMANCE OF TPR:WORK FOR WHICH THIS PERNOT 19 HHU".I SHAH EMPLOY PERSONS BUNECT To <br /> WOR[MAPFB F JUIFORNIA.' T A AN T CALL 24 HOURS IN ADVANCE FOR ALL AWMRID N�ECTMNN.COMPLETE OAAWFIO BELOW. <br /> SlOHEO .. +' <br /> 'PLO7pLAH'IORAWTO'M:AID�ALY 'm <br /> I.NAMES OF STREETS OR ROADS NEAMET TO OR SOUNOUNO THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DIWOaAL SYSTEM OR PIOP099D <br /> 1,OUrtmE OF THE PIOPTTRY,WTtH bIMERS1oNS AND NORTH DIRECTION. EXPANSION OF SEWAGE OMPOML SYSTEMS. <br /> I:DSJEREOEIFO OUTLtNE@ AND LOCATION OF ALL EIG9T1H0 AND PROPOSED STRUCTURES. S.LOCATION OF WEI"Na7FBN RADIUS OF ONE HUNDRED FIFTY.FT.ON. <br /> INCLUDING COVETED AREAS SUCH AB PATDS ONVEWAYB.AND WALKS. THE PROPERTY OR ADJO9BN0 PROPERTY <br /> .o.. -P. ......... <br /> V <br /> --- - ..h - <br /> el <br /> ia <br /> .. I...... rr. <br /> ............ <br /> i LEAN- 6 1� 9 <br /> . <br /> OMENTJO ©HEA1,7}! ry310M <br /> - `,mow.-Ct'-v„ ....... <br /> �� <br /> � 3G XZ ` I `i' <br /> .... ;... <br /> ...... yy <br /> 1/�`FOR ARTM T usE ONtr - /� • <br /> APPLICATION ACCEPTED SY C 7 DATE- ARFII.�G <br /> TANk NSFECTION.GY DATE FMALINSPECTIONBY D TE <br /> AA <br /> FFAC, � v <br /> AOCoGNTNO ONLY: AID, <br /> PE CODE FEE INFO AMOUNT ARM Ilp lac ASH RECDVED DT DATE oft NIMS9I IHYDICF, <br /> Pdb.HeelkP Sm.-E_nvft.lR M%) <br />