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SAN JOAMN COUNTY PUBLIC HEALTH SERVICES <br /> a.> EMMUNIVIENTAL RIALTO DIVISION <br /> PA BOX 388,304 EAST WE?BERMENUE STOCKTON.CA SMOI M <br /> 120914563420 <br /> y WLR-EE0NOA61[FERMT MINES i YEAR fIM0 DIRE <br /> rAM*ttt M TFIpIkOXBI <br /> APPLICATION'S HEREBY MADE TO TFR BAN JOAOWN COUNTY FOR A PEAUTF TO CONSTRUCT ANDAIM NSTAU TIE YORK OESCRMM,Tlf$AETLICATM tOMADE W COMUANCE MTYN SAN <br /> JOAOUN COUNTY OpmuopmFNT TML 4MALPTER&I T TO.S AM THE WTANbAFkM OF SAN JOAOl1R1 Coumv PUSUC 14EA4.TH SERVICER ENVENOMAvENTATL�HEAETM OMSIoN.I�rr <br /> JOS ADOPESIUOR MN/ G $ •L I,G- CR,' yL�JY.1'.`J _ ROT ORE <br /> OYAER'S NNAE �1 ADORESB PHONE7F <br /> 6 3 OW <br /> CONTRACTOR-Tr MC, �AOOhEBI EF C'.JY^�I +}/ UCF��PrypVF��'�'T'T—/ <br /> BLAB <br /> CONTRACTOR ADORESB L � /2,t/ PwwF <br /> TYPE OF SEPTIC WOM NEW HLSTALLA"OR PRPABHADOITION OFATHVCTION <br /> OID SEPTIC SYSTE PI MfFTEO W PUBLIC 5rA%R M AVMASLE MAIMN"O FEET OF"ko;NO.I Mat TESTTN I I How MANY <br /> APMRMn i <br /> @STALLATLDN WILL BBN[: R/ q Eg"ME O�" coMMERnAL 11 on" <br /> mmom OF U%mm-arm _-.( I —%M aF f<DROOMO:�_W,mm of tiAAPEV,YEf: <br /> CHARACTER OF BOIL TO A DEPTH OFF 22 FEET:IAFPRTf&VW SOIL C14APACTM WATER TABLE OE4H L y <br /> �' �,_•�^ <br /> i SEPITC TANKAwtuiE TRIA�PI 17 TYPY/ O CAPAMY No-C'OWARLYENT0. <br /> LLA <br /> I PRO TREATMETT PLANT D1137MDE TO NEMEiT: WELL FOUNDATIOPI�__I— FTIOI'tMT'T lWf .L U <br /> LOT STATION E] SIZE TYPE OF PUMP SAND OIL SEPARATOR P:NCLOSM EYGnMI <br /> LRACI#NO LINE CI NO.a tFNOTN DF UVEB ~ y-STANCE 70 NEAREST:vvFu iOUEl011TI05+ ff1d..L1H1:- i v•� <br /> FILTER DID ❑YYIOTLI LENOTH„„ 9LT't/7 DR7TAwA TO NEAREST:LVFOl_t6a.�.fDUNDA7iDN PROpERTY LINE —• <br /> MONNRW 113�YNOTH_U EMI'm DEPTH_DMANCE TO NEAREST:WELL FOUNDATION PFPPFRIY 11E <br /> a(SPACE RKi a DEPTH ,'am � NVMiER I DRSTANCC TO NE'WSf:YLa1 FOWiOATION wgPERT V Ml <br /> "U"" 13 YNOTH ![NOTE DEPTH.dSTANCf TO WEAKEST:WELL.FDLIFIDATlON PRDi4M1'Y UNE <br /> O omm POM ❑WQTH tENOTII OEPFH DISTANCE TO NEAREST:WELL 5UtFWATMN PROPERTY LM_ <br /> I HH llff C9RTWY THAT I HAVE"WAIED THIS APPLICATION AND THAT THE WORK WILL BE NONE N ACCOFOANCF WITH SAH JDADNN COUNTY OMNANCEi AM STATi LAWS.AND RbUj <br /> AND MULAT KM OF THE BAN AMMAN COITMY.NOME OWNEKORLICERLEO AOENT'B MdHATUNE CtFMnEBTLE OF TL1E WOMFORWMICFI <br /> THIS PENNT i8 MKIED,I ENALL NOT PAWY ANY PERSON IM NON A MAHNM AS t0 OMMME SW J T TO VM KMAH'S tOMPENEAMOR LAWS OF CALEOgLIC'WHTNM,T M%$000 011 <br /> MMOWPACT146 MaNATIRE CERTIFIES THE FOLLOWINO!'i CERTIFY THAT N THE PERFORMANCE OF THE WOFK FOR YRSCH TM@ PERANT LS IOSUEO,f SHALL EMPLOY PE001M SUBJECT TO <br /> WOM MAN'S COMP"41MI]N LAWS OF CALI A.•tNE A►POCAAtT FERFSY CALL 24 FIOLBNI N ADVANC[FOR ALL Fgp151BFIiD INiPEC71OMB.COMRETE TMURL1MIo CEIDW. <br /> nORALD K T+TIf: 72Z __OAYE` Yi <br /> f ROT/LAN dWlAW TO SCALE!SCALE----to <br /> i.NANICS OF WREETS OR{TOADS NEANEBT TD OR BOUNOBFS THE A1OFFMY. 4.LucATIDN of HOUSE BEWARE ODIPOSAL Fn, OR PITDPOSM <br /> E 2.OUTLINE OF THE PROPERLY,WITH IMIM"IGMM AND NORTH ORYCTIDN. EMPANMOM of MWAdk FIM <br /> IMWOMAL BYRTS. <br />! <br /> J.ORAEN69WID OU MES AND LDCA7t0N of ALL EKISTIM AHO PROPOSED BTRBICTIREV, S.LOCATION OF WELLS WITHIN RAORM OF ONE MVKD E4 FFTY F7.ON <br /> NCLMMM COVERED AlFAO allen AS PATIOS,DRIVEWAYS,AND WALKS. NEE PMOPERTY ON ADJOLHNLS FHOPERTY. <br /> •fr <br /> J <br /> 64 <br /> f7a vs'� <br /> 0 <br /> d <br /> x <br /> JAN! 8199 <br /> .. <br /> 'NV(lfl AIAFF �C 11 <br /> ( MiPARTNUMT USE ONLY 66 <br /> APPLICATION ACCEPTED!FY t L.F DATE: a AMEA g G <br /> 7 DR MSIfCT3ON SY DATE t r l r ii�L FBiAl SIRPECTpT/SY. RATES 1 `int 7 <br /> AOOR�AL C�TiTe: <br /> ACCOUNTNO ONLY: MI/ FACO <br /> PE ccOE LO CHH" IN RDCEvED BY DATE SR E P% MT MUNUM WMCE B <br /> Lb <br /> Pub.H/SNL GWv.-EIYMD.174 <br />