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EFFA <br /> ` APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,446 N.SAN JOAQUIN ST., STOCKTON,CA 96201 03HR <br /> 12091 460-3420 <br /> X. <br /> MON-XEFUXUAXLF PERMIT EXPIRES I YEAR FROM GATE ISSUED <br /> IC"Wits IN TliplpxMl <br /> AF ATIONWHEREBYMAOETOTXESANmAMINCOUMYPORAFEBMRTOLONSIWICTANDMRINSIMLTXEW WDEWWBED.TNI6 ARLM:RTxIN IS MACE IN COMRIAHCE WnN&W <br /> I.A.U.EOIINIY GEVELOPNENT TRIS,CHAPTER 8-1110.3 D THE STANDARDS OF SAN mAW W COIINFY RIODC N.TN SERWCE6.ESIWON AL HEALTH OFASID.. <br /> `7 yy / `� 7 y- M/yrt <br /> mO A.A.M./MnI w ! :(. /.li �,y-���/l�cm ��.a /Ff'-�:!_' Lor clzE <br /> OVMER'6 NAME j�SE I� ITApORE66 RIOXE�� <br /> LammwclOn 7 rT �r u R.,� wpnE33 � '�, -� 2., ./ uca[ RroNE tL26�0 <br /> 6Ve roNTMROR AWNESS LICI <br /> TYPE OF SEPTIC WOW: NEW INSTAIunoN❑ ...,SR,❑ oE6mDcnox❑ <br /> IND SEPTIC SYSTEM FFRMIITED IF FVBUC SEWER IS AVAIIABIT WRHW ROD FEET OF LLBUILDING.I RIC TEFNII I I MORS MANY <br /> /e' RAPS.E <br /> IN6TAATOX WILL SFAVE: IPEMOEHCE❑ COMMEPGW.Q� OTHER❑ /T <br /> xLWam OFUVIHOwRE:J_xvABa O(FIREPw�D/�Me: xD6wa of elFlDrm: <br /> CHARACTER OF SOIL TO A DEPTH OF 3 FEET::' pIT9WAI AS.CNMWCTTR: WATERTABLEDEPT" <br /> - <br /> '7C TAxxIGREASE TRAP ❑TYPOSAFD CC, AD cOSwAmFE . 2. <br /> PA.TREATMENT PLANT❑ a3rAxcE TO xEMur: WEll wDRATxNI L_ (! PROPER,,IME' F' -t <br /> SRA UFT STATION❑ 61EE TYPE OF PUMP SAM ON SEPARATOR IENaASw WY Ehll ,f <br /> IFACXNO DME <br /> 13 AD,A IENGTH OF..E6 .�-.�' 4En'� mGi pISTANSE TO NEAREer:WELL UN..Ai ��. WOPFl.E lPG <br /> RCT.BFO ❑WOTF -RADII D9M�pSTANDF TO NEAREST.WFl1 FOUNDATION RpPENTYUHE (` <br /> MOUNDED 13W1Di11 NST.-DEPTH DISTANCE TO NEAREST.WELL wVNDATION HPFN YUNE v <br /> e@ROE RS T❑,r DEPTX� NUMBSR�DISTANCE TO NEAREST:NLL wUN--N w.OFERTYISFS LM <br /> �' pVMOTHyy�/..IFHOTN r +y OETTH�N..'TO HGlE6r:NFL.2.gp 1 wUHOATON�jpiWJFERTY UNE <br /> deRSAL PON. ❑WIDTH ENGTH_DEPTH DISTANCE TO NEAP£Sf:WELL FOUNDATION_PPOPFRIY UNE r <br /> I HERESY CERTIFY THAT I NAVE RYPARM THIS AR4MATMIN AND THAT THE MRS WILL SE CONE W A NDANS£WITH SAN ADAGASN COUNTY ORDINANCES AND STATE 1".AND PANES <br /> AND PEGUTATIONS OF THE FAN MAWSH COUNTY.IpME OWNER OR LICENSED AGENT'S SMATUIE CERTIFIES THE wUDWING:'ICERTIFY THAT IN THE PERFORMANCE OF THE Ng FKFOF.ICX <br /> ` THIS PERMIT IS SLUED,I SHALL NOT EMROY ANY PERSON IN SACH A MANNER AS TO PELOMF wBJECT TO NOW.MAx'6 COMPENSATON LAWS OF CAUFORNIA' CONTRA STON..'PER DR <br /> SVBiOMRACnNO aOXATVRE LERTME9TME wLLOWING:'ICURIFYTHATMTXERVOPMANCEOFTHEMM1 RNMICHTHISKWMISIe M.ISHALL EMROYPER60NS6U HTTO <br /> MARIAR'6 COMPEEN'SATOR 1AW60F CAUwRN1A' THE APPLICANT MUST CALL 34 MURS IN AWANCE FOR ALL AEOMRSD INSPECTORS. COMRETF DRAMIG BELOW. <br /> fT/44, �C <br /> Swxmx / ! t7,9L'C % TR1e c/ wTE: <br /> I� <br /> _x 0.01 RAN DRAW TO...I SCALE <br /> 1.NAMES OF STREETS OR WAGS N PERT TO OR BOUNDING THE PROPERTY, 6. WCAT*N OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> nWWRH <br /> 2.OVTIE OF THE FPERTY, DIMENSIONS AND NORM DIRECTOR. EXIA...OPA .E DLSweAL 6YSTM6. <br /> S.ONAENSASNED OI NES AND WCATION OF ALL FOISTING AND PROPOSES STWCTURE6. S.LOCATION OF WELLS YATXIN P U3 OF ONE HUNDRED FFTY FT.ON <br /> INCLUDING COVEFEO AREAS SUCH AS PATIOS,D V VEWAYB,AND W.Vx6. THE PN RPERTY OR ADmINIXG PROPERIY. <br /> 1 <br /> SERS <br /> / <br /> r <br /> �d° � f Z> <br /> _ � �, v1r`oi,�c j �`� µ`��,1``s•5 <br /> e I \1 <br /> s Y: <br /> za <br /> EPMTMFNT USE ONLY q C <br /> IIMF'EJD,,KATgN AC[EPRO SY�� �® (n �f EZ R SATE: ' �G T,J ARE. <br /> �rv.�OR BUMP IN6FECTION BY GATE , L_f R.AL W WECTION BY4L DATTE�E�(��/Z'p��P / <br /> r ANnL COM 'MENTS: 3f <br /> WRID <br /> DIS <br /> O.I MOI FAC. <br /> NESS. AMOVNTR@MREO C IU/CASH DATE p/PWAIT NLMB6L IMVdCEI <br /> i l . 5"•28v ' <br /> r t ,4, ' <br />