|
A ';rh�i. S .-;'iq a.'�'! T'� lib; ',✓� 8s�'T�y�uA. / �.' - �. /� 5-
<br /> ke
<br /> APPLICATION FOR L1GU10 WASTE PERMIT
<br /> SAN JOACUIN COUNTY PUBLIC HEALTH SERVICES
<br /> a.Fy
<br /> ENVIRONMENTAL HEALTH DIVISION
<br /> A 4 P,EF,BOX 309,446 N.SAN JOAOUIN ST,SYOCKTON,:A 95201'0368
<br /> w � 11091 469•3420
<br /> FILE C
<br /> 5x . RON-it pRB R p1RFS T A 011 LITE 18511
<br /> f LE PTR .J —�— _
<br /> 1TAMplPtP 10 NPIA"td _
<br /> Arr7FCATmIs w.mav bsuk.TQ r1[SAN�louM 111�YANh INFOXTtt'l %?BAN AA(t.J MOTALL PUllTHE WGMIC DIDCf111Y1CF 81N:1PU.MI�MTN NIM MVINON.. Y NO M1
<br /> 44 JpAp1�1 CpuuTT(rtyRol�.ttNi 7iTl/C /.t ''N r'- low NtF
<br /> - u•,.��... v{ AO.AOOIRB.'Orl AJMt {1 i ! V rS i
<br /> �� h 31. r,• ADINIFE. r' �,.,
<br /> •,, ovourwr.NAM[ - rKF MOM
<br /> n cONrlenc7oR - �.�—rte..--•—' Arx"" ''l.7 FNQhr 7 Z
<br /> :i - - ff�•\. i'' k,—f 1 ^ ADOq AA- �----��ucF
<br /> •. ; :LFL[OMRACT_.,� ' —
<br /> J
<br /> 7J t KfF rw
<br /> y' WAMADDIT1o1F Ll MawY1W:M1N
<br /> ❑ i
<br /> Y �{' TM of LOIIC YFONK: NiM 1N{T111uT10N .pFC TFnr1q:'Now MANY
<br /> A rM
<br /> t k y t Bm Kp t C BY.Tw KAL"Tto IF KMLiC B[WM a AV A GABIt wTi l 71P rin of eDnDrHD, —
<br /> {tdy
<br /> uy. a1MR E7
<br /> IwFLTAtLATgN nwt BB'M: IQFAKKCt E] cOMMtRGIAI O —...�----�----- -- i
<br /> a mch &K OF wms,rttE: L
<br /> NukumI uF NVwo IFN".: r4t"al or"P mOM.: f WATFA TAALL DtVilr
<br /> AP
<br /> r/•, n?Mj BOA CHAFI
<br /> ''
<br /> cKuvcTEF1 or MOIL TO A OMH 00
<br /> F-EFr1[LT: � 1 Ty NQ.ceMF'MTM[H,6
<br /> „`, rz ♦n
<br /> Aram LL TANNACA[A
<br /> q raee.IDa1nH rnOnP7Y lrN[
<br /> PoolTwIBATH.NT rE O*xT mAr,wca To 1FEARFBT: wtll
<br /> tYP[WPIItAP .AND OIL UPARATCT RNCLo&[D CYFTFi:1 f AROPtRTY UH[ 1�
<br /> .1010010 .ITE— -•�j - FOUHDAFIOH -- ,
<br /> K s: F d5 k "• 1.!_/ brOl*NCE TO rr[ARTrT;WEIf,^ �-
<br /> ,� k ,1 L Acm"im NO.B uNwwvH a t11EB,�� �- FOUNOA:AH PROPERTY LFK
<br /> p*TAMC[TG MAREF'f:N'YLL t
<br /> Dl PTH $
<br /> PLTIRIND �MfmTN• LL TH' oEFRH pSTAF10E TO MAHE7:1H[LL FoUMnAYtoN PIIDPIIIYY 11N[�,,,,�`... €
<br /> QWIDTN E[NOTH '-PROPEFrTY IME ,
<br /> C+' MO{ B® +� ��NHMAF.R DIRFANCE TQ N[AFT&T:WTL�„�\ -FOVNUAi%1N
<br /> R n 1 it I•,.>�Api RTL q �.f.� ro1MPATloh PIgF':rtYY 11NE
<br /> } I'WOM tLNGTH^ DEPTH OIG,AFM:7D NEAIIlET:WELL PNDRFYY ll/if_,
<br /> t •7 .tY. �w DNITANCE TO M A%E[T;WELL_ FOUNDATION
<br /> f °• a I E t ,:i.RMroIAL POND. M WmTHbFRH
<br /> r'. _ •IJP{!' ..i,.: ;xfi t.AND STATE ux.i.AND PLUS
<br /> HlGH �—
<br /> F dl wr THAT!NAVE IIEPME97lCa*PRICATIOA AND THA WILL eE DOrR InACCOFI,THCFwnNLAH'ICtAINCO13H[YOADKM*
<br /> ' •k} AP j';.rld. t, 7TON.p1'T1IE BAN JDA04RIGMMtY.1/0M[O4NVcVOAIJC[HEL7 AfiEM'r fMOHA77!*L UATIFIo ,,OnKM Os coM ENSAFY
<br /> SNATWITMPEP/QAMI LLE Qr ThEwON4FeAWIR�H
<br /> ACT
<br /> ALLA
<br /> .., -i CFFRWY TNAT IN THE HrIF/o7AANCE OF 7 FIE VVoWL Wr11GVN THIS PE TIO ,rCfM[o.I Er1/4.l EMPLOY PERSONS MRCT TO
<br /> ' y'T'. Mf tV, TtB.PF1.N!OIL.WED.1 BIIAL NOT EYPIOY ANY PEFUO%IF/CYCH A MAMvrA AA TO MOVE SUEXCT:O wOHtMAN•i CJMP[NMTION IS
<br /> QFC 1 SH ANIA--LOFITEFLOO 'i WPOM.
<br /> r / BUB.CpNT1U1CTM0 BIDNATLON CEATIFIE.Tw FOII.OYMNO' M.F[CT,ON►.COMPERE oMY4.+6
<br /> WpgUAAN'B COL CUBATION LAWI Of CALM MITA.'THE AIPUCANT MtKi CALL 3A FmW A ADVANCE FOR ALL RtOIMm
<br /> TrrLE: DATE: fl 1
<br /> I,�
<br /> PLOT RAH mMW TC CCA11:F mut .
<br /> A.�[K*'roN Or M0118L itYYAD7 pEA75Al EY.T[M OR►AOFV E.D'
<br /> xK%pYgIpON!AND NONwH iM[C110N.. [)OCATIO N OF ALLIN V OMPO.AL.YYT ON Z
<br /> p T N VAE.Or BTTRET.OR ImAD.N[AT[.T TO OR BOUNDING 1 M P/IDPERTY, f.LOCATION OF YIEWA D"I IIA"S OF ONE HUriOKQ FIFTY F7.4N
<br /> B-OURBFE OF T,1E.PImPr11TY. THE FROPFrII V OR Aol"tw O PFMP[RTY.
<br /> r¢ �.ONAOI�um CYTLFNEB ANO LOCATION OF ALL ExFPrraD Atte PwOPDO[O.YFNC7UrIEP
<br /> All L� t B4cuA)m Covirm AFEA.B1ACwr M MT1DB.pRYEWAY.,IND WAi1c..
<br /> � �rI4,` r � .: •t- � C '� O.� I� 3 j 1��j �] D. _ -
<br /> „� .1. 1 ...t` r.r �'"-
<br /> 7t F
<br /> IF �r•- �'- ! ,
<br /> i r +'
<br /> S17J,; TA « _, ,,. e .05'
<br /> ` 41
<br /> f YA W 1 SAN J(., �uli4 c;1—U.11
<br /> S ,w ©lC� r UBLIC HEALTH SERV16"
<br /> 2NVIRONIAFNTAL;4EALTN 01 15 'I
<br /> 1 10
<br /> rF FOR la"MyYEKT IME Q-V �► �^7
<br /> AREA 9t
<br /> AMUCAT"ACCGPwM BY G ,� • � DATE t��� j
<br /> DATE i I FINK rIY6RCTRH BY ,
<br /> ,u;pA;;.�r*1 7AMrL!R OR Bl1IrP Qf.r[CI1ON C
<br /> �W� s�7 AIOorFT�IFKco7rAl+rt. - �
<br /> �Stly` FAG/
<br /> fn �}K tixOOL. Tn wP9 AAnUNT oI "an (AQA/IOAL:F n[cOYm
<br /> BY
<br /> BATE
<br />
|