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APPLICATION FOR UUUIU WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ` IU.plau III TT4f u1 <br /> AIRKAH,N RI HEREBY MAGE TO THE BAN JOnOUm COUNTY MR A IERMR TO CONRTMICT AN OOR INSTALL THE NOW DESCRIBED.THIS APPLICATION IB MAGE IN COMPLIANCE WITH RAN <br /> oo.. Duv rY OEVELORAOEr Trrq.CHASER 0-1110.E NA TXF R AMS OF B>N 10AOUIN COUNTY RIBUC NEALTN 6ERNCER,FHNROMMEHFK XEALTN dNWON. <br /> cm LOT SUE <br /> OWNETR., }^�Y' ADORERS / FHCS <br /> ~ coHTEIACTOR J`i of/4N/'L 5'Pe•f,[ {.Sfw nmxsR /''/�N G�e!'N.,'l�^' c/% MLr 71rw3 WoxE�Sl7r'"T�.P/ <br /> Fw CONTRACTOR ADDREAR ISE RIONF <br /> TIRE OF BEFrC TYBML: NLW IN.T.LLA RVAINAOdTIDN® 04,FIVCTNIM M <br /> LSE IM FEmC SYS1EM 1ENATTED IF SHELL,eEWER IS AVASABLE WREON 20D FEET oFaVlWlNaa P91U TN1HII IIMN'MMIT <br /> M/ISBM F <br /> mrtAuwnoN Nnu BEAN. REWDExcF�d CouNeT.1u❑ , /OTHER 13NVABkH Of LMNO DATE. NIMH OF BESAD—: Y NIRNP OF MFIDYHR: <br /> CHANCIER OF ROA TO A OF9rM OF 3 FET: C <br /> ..0 TA.... ❑TATFMCP CYAVLACr61:MUyWAT®TF0.DLEPOTHHP <br /> ARTMN+rB <br /> RAO TREATMENT RANI RO"O'I'LA 2 <br /> LIFT STATION❑ WII TYPE OF�N/M BAND OA SEPARATORYR <br /> LE-CLOSED SEAII ! <br /> LEACI.MO <br /> USE 0 M.R LENGTH OF.. �l �/C'YT I dtIYLCE TO NEAREST:WELL AL,J' F FpUNMTpH '^L PROFERTY LINE �C <br /> ^ FILMS BED ❑WIDTH uRRTrN DEPTH d@TANCETONEAREMINELL FOUNCAIION�RIOFERTY UNE <br /> .F.Dp ❑WpTH LENGTH DERTH, DISTANCE TO NEAREST:.FII FOUNDATION TJPERTY ONE <br /> e®ADE RT6 ❑DErt BQf NVMBEP�mST..TO NFMERH EVRE RDUMATIOS�RNFERTY USE <br /> SWR El PTH LENGTH OEPTX�dSTANCETO NEAREST:MELD FOUNDATION EAUERTYUNE <br /> pU...M... ❑WIDTH LENGTH DEPTH d6TANCETO NEAREST:WELLFOUNDATRN_T➢RRTY LINE <br /> I HERESY CERTIFY THAT 1 HAVE IAEPAMD THIS AWUCATION AND THAT THE NOW WILL BE DONE IN ACCORDANCE NPTH SAN AAOUW COUNTY ORDINANCES AM STATE LAWS,AND RULES <br /> AND IROULATRINB OFTHE RAN-OA..COUNTY,HOME ONMERORUCENSED AGENT'S SE NATORE CENTRUS THE FOUDWINO:'ICFMNYTHAT ENTHE PERFORMANCE OF THE ME'ANICH <br /> NMKWMIRIWM,IWALLNOTEM0. Y/ RRWNm WILNAMAMIERASTOBECOMENBJECTTONOIRMAMSCOMIEMSATPNIAWBOFCIU M&- CONTRACTORSNWNOOR <br /> LISCONTR\RINO BIONAULM CERTIFIES THE MLLCWINO:'I COFFEY THAT IN THE PETTOWANCE OF THE N9M.FOR WHICH THM STIR IR ISSUED,I MALL EMPLOY PERSONS SUSIECT TO <br /> WOR(MAN B LOMRNB �,"!�/JW�S/p�CAUWPNIA' <br /> THE..ART MUST CALL 24 MVRB IN ADVE.NCE FOR ALL REQUIRED IMS ICTNNS. COMPLETE TRAWmD BELOW. <br /> .. 6ICNED. wT/// TITLE C/t.LJ,NV DATE: <br /> ROT RAN.TO SCALER SCALE <br /> e OF @THEFTS OR MADS NEAREST TO OR ROUHpNO THE RIORE1. T LOCATION OF HOUSE SFWMF d6MSAt SYSTEM OR RIUMSED <br /> 11H.OF THE NVRR ,WrtH OIMEMWOHS AND NORTH DIRECT.-, IXPULSpH OF SEWAGE..MSAL SYSTEMS. <br /> ]. WMENWONED OUTLINES AND LOCATION OF ALL EXISTING AND MOMSE0 STRUCTURES. R. LOCATION OF V HJLS WTTXIN RADIUS OF ONE HUNDRED FIFTY IT ON <br /> NLLUDINO COVERED AREAS SUCH AS PATIOS.DR VEWAYe.AND WAVES y'�q THE <br /> /PROPERTY OR A OIN NO PROPERTY. <br /> v <br /> 1�liN�L - q <br /> �� c � S <br /> I�,LIa <br /> 1 y <br /> Puce r I "� ncEe <br /> Fla,;la.wMFw -.r1^ nvLxl�,. .y <br /> .� t♦� //� � iOR OF➢M TSI ENT USE OXLY � C <br /> APPLICATION ACCEPTED BY �L�'AV•V• N��� Vr E `(.A/dVjDATE: 7 ADFA:-2- <br /> 11 <br /> IANS.M OR SUMP IHSPELTIOU BY DATE I / TRIAL IMPECT.N BY <br /> ADDITIONAL COMMENT6' <br /> CCOUHTNO ONLY. MDl FACE <br /> ES CODE FLEINM YAOUNI REM11Tm ITEC /CASH RFCOV®RY DATE W/REMIT MMNFR mVO10EI <br /> L <br /> PUE.HeRItE Serv.-EnvlrO,174(3561 <br />