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BRE <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,304 EAST WEBER AVENUE,STOCMN,CA 95201388 <br /> (2091469 3420 <br /> NOR REFUNDABLE PERMIT EXPIRES I YEAR FROM BATE ISSUED <br /> (C-EI 1.LplloR) <br /> AIgECATION In HMFBV MADE TO THE BAN JOAOVM COUNTY WR A PERMIT TO CONSTRUCT AND/On EIRTALL THE WOR[D A,,AS D, THIS APPLICATION IB MADE IN COMgIANCE INTX SAN <br /> SIR JOAOWN COUNTY DEVELOPMENT TITLE,CHAPTER 8.1110.3 Ano THE STANDD�ARDS`O,F SAN JD'AMUE4 COUNTY PUBLIC HEALTH SMNCES,ENNMHMEMAL HEALTH.11INON. ( / <br /> JOB ADORE66T0.AFRI�.Er.1111 I�1('. L -I ( It'l' (11"VI ^ri•� �F�(Y ) CT'L.�C��L._•.(�1'1 - LOT <br /> 1 C� <br /> OPENER'S NAMES I.LIIl(.l'!(T'Y 1`{t•. Lf ADDRESS 1�:^i Ul If UI..(�T I Ll"e -/PpNf 1!4 (,24' �I`1 <br /> ABB I ONTRAnon1:4i.•,I I / F1"rZ i •- T_ADDRERS I,1_Fi_r. 11- Y,A uCE <br /> .VB COMPACTOR ADDRESS---Cl PHONE <br /> TYPE OF[EFFIC WOXx: NfW IM{TAUATON❑ RA4RADDITION ❑ DEBTEDG,K.❑ <br /> REE <br /> MO SEPTIC SYSTEM KRMTTTED IF PUBLK AMER IS AVAILABLE WITHIN IDI FEET OF BVILDINpJ RIC iG}IN I I Fp W MARY <br /> APMe•F P <br /> INSTALLATION WILL[p(VE; pF610 ENCE❑ COMMEMIAL❑ OTHER❑ <br /> X VMSq OF MRIM UNITS:_HVAFq OFSFp100M6: XIJMRq OF EMROVEM: <br /> CHARACTER OF SON.TO A DEPTH OF T FFEE; PT/SUMP SOIL CHARACTER: WATER TABLE DEPTH <br /> A► [EPHC\AXpMG6F TRAP ❑TYPEMR CAPACITY NO.COMPARTMEMR <br /> AM TPEATMdT PANT El d{TANCF IO NEMFIT: WELL__ FO VNOATpN PROPERTY IHiE <br /> UFT tTAT10X O 612E TYPE OF WMP SAND OIL AEPAFAMR•ENCLOSED 6YSFEMI <br /> IFACMNO UMF ❑ NO.EI£HOTH OF LHifB OISTANCF M NEAREST:MELL FOVNDATWH FMIERry UNE <br /> PLT... ❑VA STN IENSTX DE'. MnYANCE TO NEAREST:WELL FOVNDATbN_PMfERTY UNF <br /> SIR MOUNDED ❑WIDTH UNTN DEFTH.DISTANCE TO HEARER:N4LLFOUNDATION_pgCUR,UNF <br /> .NMPS UND'SIPMPA4RT{ ❑DFPTX SUF NUMBM_DISTANCE M NEAREST:WEPROPERTY M.HOAT.N PROPERTY•TIF <br /> ❑WIDTH LINDEN DEFTH� DISTANCE TO NEAREST MU.FOUNDATION_IR,K"UNE <br /> d6btLL FOX.{ ❑WIOTN UNOTH DEPTH DISTANCE TO NGnEST:WELL__FOUNDATION RpKNTVUM <br /> 1 HERESY CERTNY THAT I HAVE N AND T.-Al1 E OR(WILL BEWMMACCOMANCE WITHtAN JOAOVIN COVMV ORpINANCEn AHO STAY GWS,ANO RVU9 <br /> ANOnMUTATRNSOFTHEBAHMAWINCOUMY,1pMEONH ROAMENSED OEW'BSIONATVRECEWHIESTHEFOUO NG:'ICEROFYTNATINTHEFE WANCEOIIK.EEFORYTRCN <br /> THIS PERMIT ItISSUED,I SHALL HOT 1.111 ANY SEASON IN;UCH A MANNER AS TO BECOME SUBJECT TO MOIKMAH S COMPENSATION LAWS OF CALIFORNIA: COMPACTOR'B MI <br /> SMM <br /> UBLOCTMO SIGNATURE CERTIFIER THE FOLLOWING:-1 CURIFY THAT IN THE PERFORMANCE OF THE M9 R(MR WHICH THIS PERMIT 19 ISSUES. MALL FMKOY PERSONS SUBJECT <br /> PoN000. <br /> RING TO <br /> WORKMAN'S COMPENSATION LAWS OF CAUMRKA.' THE AR CAST MU[T CALL N HOURS IN ADVANCE FOR ALL REOMRM IN{SECTION{, COMPETE DRAW1H.BELOW. <br /> E� <br /> SIGNED z (�J�[. Q�_ TITLE:612 If ju OATE: S IL�Oy <br /> ,LOT—NMW TO...SCALE <br /> 1.NAMES OF STREETS OR MADS W ARE.TO On BOUNDING ME PMPERTY, UwM.LOCATION OF MDYBL BEWADF OISbtAL[Y(TM DA PpbYO <br /> I.OUTLINE Of THE PROPERTY, LOCATION .AND NOW.DERECT., [RFMIpDN q{fWApE OMMSAL SVrtEM{, <br /> _ 1. I.E.S.OMED ONLINE6 AND <br /> tCCATIM W A VRPTONI AND Pp WEED 11US TVK{, {.LOCAPON OF NtLLB MTHXI MqU{OF ONE MVNp0.fD f1Fry FT.OM <br /> MCLUDENO DOWNED AREAS SVC.A."'-a --l- <br /> 68.26 <br /> Aun wAlxw <br /> Tr<r,:m ne�n wv�un arUKRTY, <br /> 68.26 ACRE PARCEL,APN 229-08-18 11NOH•41MFT <br /> - MAGNOLIA ROAD N <br /> aq <br /> - Pt• ' w <br /> KEEP \ 11 32 ► ; 03 , <br /> 68.26 Aa <br /> i•S <br /> PAYWNT <br /> ♦ P ♦ . 28 AN 1oz000 <br /> P <br /> 19 SAN.IOAQI IN OOU,T• <br /> ONMEM4IMWLTHDNISIOn- <br /> f <br /> � APPLICATION ACCEPTED BY - � / DATE: AREA <br /> TANK,PT OR SUMP INSPECTION BY DATE / / FINAL INSPECTION BY DATE / l <br /> ADD...AL COMMENTS: <br /> ACC OVHTNO ONLY: AIDE FACE <br /> PECOOE FEEINM AMOVNTn—TT. CNECVKASM ...WO BY GATE M(P.MNT XMMBq INVOICE <br />