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APPLICATION FOR LIO010 WASTE PERMITlIHRL <br /> SAN JOAQUIN COUNTY PUSLIC HEALTH SERVICES <br /> E VIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 <br /> NOR• EFUN ABLE P.ERMFF E%WRES 1 YEAR FICIN BATE ISSUED <br /> ICeRIpI/t/M TTipRnl/I <br /> APPLICATION IB I INESy MADE TO THE BAN"ADM"COUNry FOR.A P101,111 TO CONSTRIkT ANDAIR W <br /> INSTALL THE ORK 1110C"1111'7166 AppUOATION IB MME IN COMPLIANCE WRH SAN <br /> I^ ITRLE("C�lN ER OM ION <br /> IOAOUR0.3 ANOT6TP GAN JOAOUIW PUBLIC HEALTH SERVICE&EIROMMExrM HEALTH . <br /> BI2E/( Qc / LOT -�' <br /> 1 JOB ADDRE66/OA APNr <br /> upF 1 � /I <br /> OWNEWt NAME � A11DNE56_ - - - <br /> ADDRESS VCR PHONE <br /> CONTRACTOR <br /> •''� <br /> BVS CPMRACTOq � �^ABDPE6s 4 f` <br /> • OE/TRVCIMN❑ <br /> TYPE OF O_WtlRN: NEW MSTAWR716N A'EPAWAOdTION❑ P3lC 7FBTIH 1 I IIOW MAHy <br /> I`IRM SEPTIC SyRTEM mFIMIrTED IF PUBLIC SEWER IS AV WITHIN E00 FEEY tlF BDIIOIND.4 APpEutlen/� <br />` INETAMATEON <br /> KEU/M9TN/E: 13 OTHER. <br /> S lSOI�fTMHPrENSR <br /> LZ <br /> I,--TOFMO NMFROFs➢ OM/: 0V❑ME <br /> 61 OP C6LIEPRL�0�DATI�ONi•—r) ATEA TABNEOOP6 <br /> q <br /> TPAOFPTHOF]TFT: CPMPAATMENTO <br /> L1T- ` AAC �'MWVPROPERry UNE�FAFIA� <br /> T❑ <br /> SAND OIL SEPARATOR(ENCLOSED eVBTEMI <br /> LWT <br /> iTAT10N❑ 612E IyPE OF PUMP �'D^ <br /> a I.ENO7Tr OF LINES qK?ea- DISTANCE TO NEAREST:WELL rOUNOATRm�"wpE fy UNEP^_ <br /> LFJIOI✓1NP UNE �'' <br /> T FOUNDATION PROPERTY UkE <br />� FILTl�IED ❑W{DTH IETtOTH DEPTH DISTANCE TO NFJIHEBT:YYEUY - <br /> E c FOUNDATION PROPERTY UMI`_ <br /> MOUNDED, ❑VADTH EtTIOTx ri DEPTH DISTANCE TO NEAREST:WELL //�, (f o —PUT' <br /> UHE —'✓ <br /> SDE 3+c� _--OUMB�d6TANCE TO HEMIE61I WELLY^_FOUNDATION <br /> iFIDAOE FRi: PASTERN UNE <br /> yRp�TH LEMBTH DEPTH DISTANCE TO NEAREST:WEL.L��POUNDATpN <br /> DISPOSAL <br /> LLyy FMMDAT10N PNOPEMVUNE <br /> DI6P0/Al ppMD/ L.E WIDTH LENGTH DEPTH deTAICE TO,IEARESTt WELL - - <br /> _-I HEREBY CERTIFY THAM(}PAVE PREPARED iISB APItACATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE YYRH BAN JDAWd COUNTY ORDINANCES AND STATE LAWS,AND RULES <br /> ANO NEOVLATIONS OF THE BAN JOAOUW COUNTY.HOME OYMIERORLICENSED AGENTS MONATVRE CERTIFIED THE FOLLOYRNOS 9CEATIF'/THAF MTHEI'EIFORMANCE OF THE WON(FOR WHICOR <br /> H <br /> T1116 OF CAIJFCFNA� <br /> PERMIT IB ISOM,I SHALL CAIEO� PLO OLLOIVINO 1!i CEArNIFl//TNu T I�AB 70 BF�T71E WOFK FORVINICH THIS FUU RT 61SSUEO. BNALL EMPLOY PflEeONB SUB}ECr TO <br /> FFF���SVBLONTRACTINO CALL]//LO11Re IN ADVANCE FOR ALL REQUIRED IN/PEC71oN/.COMPLETE DRILKRNO EL1AW. <br /> WOIKMAN•B VENBATIO 4M6 (SRA.' AHr /1 <br /> TirLE: DATE-1 ^I TO� <br /> •B10NED ` <br /> PLAN IORAW TD 60ALEI SCALE •IC PJB <br /> ,LOCATON OF NOVSE SEWAGE DISPOSAL UYSTEM ON PROPOSED _ <br /> 1.NAMES OF STREET/OR NOME NEANEOT TO OR SOUNDING THE PRCPEITTY TaLPANSION OF SEWAGE DIBPOB.AL SYS" <br /> x.OUTLINE OF TIM PROPERTY,KITH dMENSIONG AND NORTH DIRECTION. LocAnom OF WELLS VATHM NADEUO OF ONE HUNDRED FIFW FT.ON <br /> J.CIMENBIONED OUTLINEQ AND LOCATION OF AIL E%ISTMO AND PRDP06E0 GTRVCTUAE8 S THE PROPERTY OR ADXH""3 PROPERTY. <br /> BiCLVDINO COVERED ANEAS SUCH AS PATIOS DNVEWAYB AND WAL"' <br /> .. <br /> .. <br /> ME <br /> Q" <br /> µ .. <br /> 2004 <br /> l <br /> AtlG <br /> I �E � sAr�aaaa t��0n��s <br /> - .......a- .. . ... <br /> gi PSI N4 <br /> ENVIR�NMENTAL <br /> ... -. L... .. .. FOR DEPARTMENT IME ONLY <br /> " �— <br /> ���,� DATES <br /> APPLICATION ACCFPTED SV <br /> �rL OATEN ,7 rSDNNAL INSPECTION DAVE f <br /> I � nSic,pR7oR BUMP MBPECTION SV <br /> (ADOIrIONAL COMMENTS: <br /> RCCOVMTATOP FACS <br /> NO ONLY: <br /> E PFE INFO AMOVM IR@RHT[O CIIECIU ASH IrEEO CDVBT DATE <br /> BR 1 R9UBT NUMBER INVOIce R <br /> PE CObE <br /> pub.HeaBII SON.-Envllo.174(3MG) <br />