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APPLICATION FOR LIOUIO 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 /> MOM-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> _ ICEmprb b TIbIsEtEI <br /> APPLICATION IB HEREBY MADE TO THE RAN I.A..LDUNIY FOP A PERMIT TO CONSTRUCT ANDAR INSTALL THE WO.DEBCNBEO.V.I.APRKATMN IB MADE IN COMPLIANCE WITH BAN <br /> AAWM COUNTY DEVELOMAEM TELE,CNAITF/A 9B 10.3 M TXE 6TANDAPDS OP R.W AAM.MUMY FORM HEALTH SHORRDLER.ENVNONMEMAL HEALTH OIN WON. <br /> MR AOq¢RBNR APMI % L / � CT /��- +C/ LOT ERE V`'L 14. <br /> A` ADDRES, /f 2 {'i 1e`4AJ ✓.E/ :.J �� Plbxe -�8 23 <br /> _ DwnfR'eMMEE <br /> COMMCTO <br /> /�/S . DIEM /��� �ClaJ•/,SLY rJ/. IICR �7t1.SL/S"imoxe��-3/ <br /> SVS COMIIILTOM ADORE. E MbME <br /> TYPEOEE9ECWOPx: MfWIXRTAWTUE PEPAWAOMININ OUTRILTIONO <br /> ,DO EfFTC WSTEM PE WE,,O F RMEW <br /> UC SER IS AVAIURLF WITHIN 200 FEET OF GUILEG10.1 IMOTEETIN''MOW MWY <br /> ASSIM MR R <br /> IMFTM.4MX WILL ROIVE: RE6bENCE ff COMMERCIAL❑ .TNM❑ ^y <br /> NUMEf11 OF UHI.UMTS: MEIRIREROE EEM1OSEAS' -L�NUMBER OF EMPVDWM: <br /> CXMACTER OF SOIL TO A MPT.OF!FEFT: P7 .^^"I+UxU-1 BOIL.NA—ER: WATER TAME DEPTN V <br /> "`"C TANRmREASS TMP ❑TVPEnAFO cAFACEY NO.cONNWEwENVS <br /> "No <br /> TRM1MM114NT 0 GOTIWCF TO PROMISE: WESL Po.AMR ETOPEMEY UM <br /> UFT BTAMN I] SDS TYPE OF PUMP/ RIND OR EEPMATOR IENCUOMET EP STEM' <br /> �^]y� <br /> L....ON. ® NO.BIEMETX OFUMS / �'C-0 INSTANCE 1.MIAMI WFLLy�PoVHOATbN -AJ FNORRIV UxE I«3U <br /> FILTERING CJ WMT. LENGTH DEFTX�MWTMCE TO IRNFED WFIL FOUNDATION_EMPMTY UNE AT. <br /> ❑WIDTH DENVER DEPTH DISTMCf TO NFMERE:WELL F0UNGAMN ��,�""�� FGFER UNF 1V <br /> AODAGE WTS © FFLS <br /> DTNISIZE 3f'// ..AREA _INSTANCE TO MAR <br /> FR :WELL���II PoYHDAMMyyy�RbPERTV LME k� .� <br /> SUMPS [I WIDTH LENGTX DEPTH MSTMCE TO NFAPEST:W,bu_FOUNDATION�EMIEMV U.E <br /> s IRg.AL POM.. ❑..T. LENGTH OEFTH�OSEANCE TO NEAREST:WMA FOUNDATION�RbPERTY I - <br /> I HEMP CEREFY THAT 1 HAW PIEYMEO TME AP%ICAMN AHO THAT THE MM WILL U MNE IN ACCOMANCEWRx SANNAWIN COUNTY IR ONA NCEB AND STATE UWB,AND PVUS <br /> AMDIEVUL V"OFTEWMMAWMCOUNTV,MMEONTFRMMENMOMEM'BMONATVPECEWIFIESTHEFOUDW :9CMIIFVTMTINTXEPEFLOIMMCEOFTN MMFORWHICH <br /> TNRFERMEMIRWIED.IMIALLNOTEMMOVAEIKE NMBUCHAMMNERARTOBEWUEB WCI TOMMMM-SCOMRNMTbNUNHOFCMMMIA' COMMCTOR'B MIWNO OP <br /> 6VBLOMPACTINO SIGNATURE CERTIFIES THE fOLLOWINO:'1CFMUITHATINTXEPfMONA EOFTHEMMMRMTICNTHISMWKIBISSUED,lMWlEMKOYPERSONSMWMTTO <br /> WOR(MAx'S COMPFNSAT IA4W\y/(OF�C�A/LFO_RNI&' THEAPPLICMTMUETCALL MVMINMVANCEMRA/LL�E"�REOURMIMSPECTONS. <br /> L./ COMWETLOMWINO MI�DYW. S <br /> SIGNED% f 1•y- ` ERIE: ��/ GATE <br /> JV/U RDT FUN 0.TO SCALER SEA E_ <br /> 1.NALEB OF WTIIEFTS M MADS NEAREST TO OR SOUNDING THE FRORRTY. -I S.LOCATION OF NOUN SEWAGE INf10SAL SYSTEM OR PROPOSED <br /> E. 2 OUTUNE OF THE PROMETV.WITH OIMENMONB AND NORTH DIRECTION. MPANRpH OF SEWADE PSPoSAL efelfMfi. <br /> ] DIMENSIONED NED OUDDHES AND LOCATION OF AEXISTING AND PROPo6EO STRUCTURE., E.LOCATION.l.WTNIN PAMVS OF.......RED H'FT.ON <br /> INDULGING COVFNEO AREA.WCx AS PATHS,ORVE 1%ANO WMAR THE PROPERTY OR ADJOIN'..PROPERTY. <br /> Ill V <br /> tc <br /> n <br /> z s- <br /> 1 <br /> ---- —-- — 7AYUENT- <br /> DEC 21997 <br /> -- SNwnAn H. t! NTT- \ <br /> PUBLIC LT <br /> ENVIRONMENTAL MEALTMAIVI IbY <br /> //� FMMM <br /> OTMENT....1Y <br /> AIGTCATIONACCEPTEOBY A^ P Mme' <br /> dl <br /> TAM,FIT OR BUMP INSPECTION 6Y DAN--[4'6�y 7 EMK IHBfECTpN OY '� <br /> AOOTIOML COMMEMS: <br /> ACCV YMTMO OMLV: AIOI FA[F <br /> FR INFO TPDXIITED 'IEC ICA6N PECOVPo Rv DATE MIPBFAIT XCMSO OICEI <br /> Pub.HSBIR1 Sery �Envir0.1]4(3/96) <br />