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• APPLICATION FOR LIOUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> '2 304 EAST WEEDER AVENUE,STOCKTON,CA 95202 <br /> �( (209)4653420 <br /> N_OWREFUADARIE PERIMLEIPINIs I YEAR FAOM DATE ISSUED <br /> r-empiNt!IN TrIPIWtd <br /> APPLICATION 10 HEPISY MADE TO THE SAN JOAQUN COUNTY FOR PMAR TO CONSTRUCT AHOAIR INSTALL THE NOfR DESCASNED,7AS APPLICATION R MADE IN COMPUAWE WITH SAN <br /> JOAOUN COUNTY DFALOPM[Nr T1rLL CHAFFER 9.1110,1 AND THE STANOAROS OF SAN JOA N COUNTY PYBUC HEALTH SERVICE!.ENNPIONMWEAL HEALTH DMtlDN. <br /> J ,`�— r �/} r��ti <br /> JON AOOIIEIl,OR A.°II/ �`• CfTY (l�M.L-a lDT SR <br /> oWHTR'S NAM�L_ C- AD011[a9< <��- _naNE_�'�� <br /> CeuOsNTACTOR�JADMBS UCF HCHF <br /> CONTRACTOR ��Y24 LA` 0 <br /> TYPE OF&TIM WORT: NEW INS7 ALLATION❑ REPASUADDITION Q DEATRUCTION❑ <br /> No SEPTIC SYSTEM PERMRTED IP PUSUC SEWER R AVAILABLE WRAN THC RET OF NULDINO.J P1SIC TESTNI t I HOW"MY <br /> SPFS•PSER/� <br /> INSTALLATION WILL 61 N: REBOENCE❑ COMMERCIAL❑ OTHER)',"' �+[q�le <br /> rLMe1 OP IL NII LINTS: HMRSDR OFSELROONS: RLMIM OF IMPWYUS: <br /> CHARACTER OF SOL TO A OMH OF O FEET: PRTASUMP SOL CHARACTER: WATER TABLE AOOBPE1! I � <br /> .. SSFM TANIMASS TRAP ❑ `� L.— CAAACHY C7'�J�� NO.COMPAITMEMS <br /> FILO THIA7MOUT J7AMT ElNSTM61 <br /> CS TO NSART: WELL A '` Lo <br /> O FGLJNDMION rm-wY U. P� J- <br /> LiT STATION❑ RTE TYPE OF NMP SAND OIL SEPARATOR IENMOSEO SYSTEMI , <br /> LIACMNO LINE ❑ NO.S LENGTH OF UNES_ OHBTANCE TO FEMR/T:WELL FOUHCATION PIbFENTYLANE <br /> SAMWIDTH_ <br /> Q LENGTH_ OEFTH OrS TANCE TO NEAAIEl7;WW_FOUNDATION PROPERTY LINE <br /> ❑WIOTN LENGTHDEPTH DISTANCETO NEARERT:WELLFCAWDATION PROPERTY UN! ❑DEFTV Sr7E _HULPSER DISTANCE TO MAREB7:VAIL ,FOUNDATION PROPERTY LYE <br /> �SLMPS ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL _FOUNDATION PRO/lRTY UNE <br /> OISAOSAL FONDS ❑WIDTH LEN07H DEFTH DISTANCE TO NEAREST:WELL FOUFDATtON PROPERTY LJNf <br /> I HERESY CERTIFY THAT I HAVE PREPARED TAB APPLICATION AND 7HAT THE WOW WILL SE DONE N ACCORDANCE WITH SAN JOAOUIN COUNTY ONINIANCES AND STATE LAWS,AND PULES <br /> AND IEOIAATIONS OF THE MN JOAGUN CO .FIDME OVNER OR UCENSM AOEHTY dN NA1rLW CEIITNGES THE FO W"m:'F CEIOIFY THAT N THE V N FORNPANCE OF THE WOAII FORWHCH <br /> THIS POENr IS ALL NOT EAIPIO PFNSON N RCN A MARISA AN 70 BECOME SULJECT TO WOMMAN•S COMPENSATION LAWS OF CALIFORNIA.-CONTRACTOW7 KAREN OR <br /> SRN co"IFIES FOLLOWING:9 CERTIFY THAI IN THE PERROR LANCE OF THE WCLR MR WFSCH 7AS PERFS7 R IYIKD,1 SHALL ELNLOY"ROO"SUB JSCT 70 <br /> M vm THS A/1UC MUST FALL 224 HOURS N ADVANCE"All NOL! DWMMGPIS.COMPLETE OMN7N SELOW. <br /> I 7 7� T� ATE: 2± 7 <br /> > <br /> � � PLOT FUN 1DRAW TO WALM RCALE •IA `^ <br /> •--,,A,� • N1ERS�RJIOFON NEWEST TO OR SOUNdNO TRI[FIVDPFIRY. S.LOCATION OF HOUSE RWAOE DISPOSAL SYSTEM OR PROPOSED <br /> 2. `- SHE PROPERTY,WITH DRP@INDNA AND NORTH 01RECTOOW EAPAHNON OF SEWAOE DISPOSAL SYST9AS, 1rY7 <br /> D 'V OF •OUTUNEt AND LOCATION OF ALL EXISTM MIO PROPOSED 9TAJCTURES. -ems S.LOCATION Of WELLS WITHIN MORN OF ONE HLIMDPID RFTY R•ON <br /> NCL [PED AREAS LARCH AS PATIOS,DRVEWAYS,AND WALKS. 1, S4TC THE IMOPEIRY OR AIMPARI PFpPFERY. <br /> CO <br /> Af em-�lj, <br /> yoa>v0 <br /> ;.SH . .. ............ ..... . . ..: ........._..........:...:........ <br /> :.. ,.. <br /> Orta--<P <br /> . ....... <br /> 1 .._. . ::..L <br /> OF <br /> l <br /> p. <br /> rtl'J•EL Ie <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE: A MEA: <br /> LANK.PTT OR SUMP NfH4C1C11 SY DATE I / FNAL INSPECTION SY `r DATE Z <br /> ADDFTIONALCOMMMTR:was 49 �garcr .A+t ♦ ik4ev4 L F LSo <br /> ACCOYNIFNO ONLY: AID/ •FACT � VJ'"^ E� SAF �r <br /> PEC SOS FEB ILEO AMOVNT IIBEITED ICAAH IEIS"m AT DATE am,PERmT HUNAM <br /> 1 2 2S`o1 /6--- D:Zo/ <br /> Put.HBlM Slrc•Envoro.174(3198) <br />