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APPLICAT"XI FOR LIOUID WASTE PERMIT <br /> SAN JOAOUI INTY PUBLIC HEALTH SERVICES <br /> ENVIRMENTAL HEALTH DIVISION ,..i <br /> P.O. BOX 388, 448 N. SAN JOADUIN ST., STOCKTON.CA 98201-0388 <br /> (209) 4683420 <br /> MON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUER <br /> O <br /> APgfLATNN IS HEREBY MARE TO THE SAN MAOU-COUNTY FOR A PERMIT TO CONSTRUCT AMSHS INSTALL THE KV RL DESCNBEO. THIS APPLICATION IS MAOE IN COMPLIANCE WOH SAH <br /> MAWIN COUNTY OEWLORAENF TRUE CHAPTER B 110/'.3 AM THE STARDAIM OF SAN MAWIN COUNTY IBM HEALTH SERNCES.ENVIRONMENTAL HEALTH ERSVO.. <br /> JOB AODRES&bq ApII c ;- -/,{��c.0 ��F/ ��//�//// <br /> Y/1 CO,'� L�F LOT <br /> OWNFH'6 NA�ME�r fI �( { (LnA. (( ADDRESS /[.i J <br /> CO.RAnvR'-ll.vzA .hjui�. I <br /> T AODRE66 .CTE E.E.NLS 7 2 G, <br /> RroXE'3Ld'-S <br /> BUB CONiRAL•TOR AOOPESe <br /> —UCS—.w ' <br /> TYPE BY SEPTIC SARMS, NIW EOTALLATHINO RV ADdRON BBTIVCRON❑ <br /> IRO BFPfK SYSTEM PFNMRTED N PUBLIC SEWER IS AVAILABLE NTTNN S.,OF BWLdN0.1 RIC TYTM I I MOW MANY <br /> APPEwBm S <br /> MSTAWTNN WILL t91VF: REBIRENCE COMMERCIAL❑_/L OTXEfl 13NIE.NUVIN <br /> ER OF O IMTS:/ .... BFOROOMS: 'J� N RANAM OF EMM1YNBEE <br /> CHARACTERNTA.OF BOIL TO A DEPTH OF]FEET. <br /> NTyIMP SOIL CHARACTER: WATER TABLE DEPTH <br /> EEPIIC TANI(/d1F.ME lM1 �T'PFRSE; 1T CAPACTIY NO,COMPARTMENTS <br /> ARE TREATMENT PIAXT gSTANCE TO R.T: WEU. J FOUNOATKN pIKPERFy UNE <br /> USE T.M.❑ WE TYPE Of RIM, 'l BAND OIL SEPARATOR(ENCLOSED SVSTEMI <br /> LEACH, UNE �E��O.B UENOTH OF ONES z '- �fo DISTANCETONEAPEST:WELL to PoVHDATNIN1+�RKfEgry UNE ` <br /> NOUR SUI ��❑ DTH LENGTH DE➢TH INSTANCE TO NEAREST:WELL RIVNOATroH PRORIry UNE I <br /> MOIMOEO OWIpTH UEROTN�! DEP. INSTANCE W <br /> E TO NEAREST: D1 FOUNOAMIS PIIOPERTY UNE <br /> OP_ <br /> SEAOE RTS gDEPTH.�81II y.�/I NOMBE ORTANLE TO NEAREST:WELLW' YA!YY PERMEHU . in' gKPERFY UNE S <br /> 6VMPS ❑YADTN LENGTH DEPTH DIBTANCE TO NEAREST; FUL-f-4`—PoUNDATION�RIORERry UNE . <br /> dFPOSAI PON.. ❑WIOTN UFNDTN pEPTEl RSTANCE TO NEAREST:WELL ,UNOAMN�PERN ryUNF <br /> 1 NEXBY CERTIFY THAT I RAVE REPAREO TNR APRICATKN ANO THAT THE W9RL WILL SE CONE IN ACCORANLE W'RN SAN JOAOUIN COUNTY ORM ANCEB ANTI BTATE UWS.AHD ROUES <br /> AHOIFOU,;TEHIS OPENESAN JOAOWNCCULTY,MN,,O,NERORIILM- AGENT'SSIGNATURE CERTIRESTHE FOLLOWING:-ICE...THATINTHE RIIfOWAANEEOFTNEWONL FES.HN <br /> THIS PERMIT IS ISSULO,I SHALL HOT EMKOY ANY RRBON IN SUCH A MANNER AS TO BECOME SUBJECT TO WALKMAN'.COMPENSATION LAWS OF CAUFOPMA.- COEEU A OR'B PINK OR <br /> SUBCONTRACTING SKHATURE CERTIFNS THE FOLLOWING:-1 CEIRIFV THAT IN THE ISHFERMANCE OF THE WOR(ION WRICH THIS♦TRAIT IB♦BELIED,I SHALL EMROY IEIISONB SUBJECT TO <br /> W011[MAN'S COMRNBATKN♦�AAALW.yyrB OF CAUFOR�MA�.',TeNF�AIRICANT MVST CALLAfKVIM IN AOVANCF FOIIALL REOUIIFO IN6RCRONB. COM0.ETE DRUM.BELOW. <br /> SIGNED �G'�/�V TITLE: I/� DATE: L.r`�\ 1 - <br /> ROT RAN NMW TO SCALE)SCALE <br /> ).NAMES OF STREETS OR IBRD&NEAREST TO OR BOUND NG THE PNEPV T . IA4. LOCATION OF MUSE SLWAGE RIBPOBAL SYSTEM OR PM,UX,, <br /> WITH 2.OUTLINE OF THE PROPERTY, H MNOFSKN.ANO MATH dRECTRN EXPANSION OF SLWAGE DISPOSAL SVBfFM6. <br /> ], EO%NSHINER OUTLINES AM LOCATION OF ALL EXISTING ANTI PROPOSED STRUCTURES. 6. LOCATION OF WELLS WITHIN MdVB Of ONE NVNOPfO FIFTY FT,ON <br /> INCLUWHO LOVEPEOpAIEAB BVL.AS PATHS.dSVEWAYB.ANO WAU(S. THE PMRRRY' PFDJ.HSM RYJPF, <br /> [[P��LLAS�//Y��ICcY�I[[E'�IPE+;,f�TP� <br /> DEC 8 1994 <br /> SAN JOAQUIN COUNTY ' <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEAL1,;DlVff! IO,': J: . <br /> � 7,,= <br /> //^f th <br /> I I 1 b <br /> yq <br /> FOR D®NTMENT VSE ONLY <br /> ARIICATroN ACCEPfEO BY DATE: �e I —AREAZI Z <br /> IAFflMFE1R BVMPIN6FEC1bNBN -�.OATE�RAL WBPECTMIX BV I.� ��TO R DATf�C� <br /> ADDIESOM COMMENTS: J <br /> ACCOUNT..ONLY: AIDE ♦ACI <br /> RE COO. EEHOO AMOUNT KNITTEDCEL. KASH RECOVER BY DATE MI PDMIT NI.MBfA INVOICE♦ <br />