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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 381,446 N.SAN JOAQUIN ST.,STOCKTON,CA Sit 144 <br /> (209)"S3420 <br /> SO&MUSDARtlPflHIT E7LMIIEf 1 PEAS FlIon SATE#MID <br /> I&.q_ i.TrbomilI <br /> APFLICATION IS HEE*Y MADE TO THE SAN JDAd1M COUNTY FON A PERM T TO CONOTINICT APIOMM I WALL THE WOR[DESCRIBED-THIS APRJCATON IS MMI M COINIFLN C[1ART11 SAN <br /> JOAOLNN COWRY OL'VHOPIAENT TRUE.CHAPTER I-1 I .3 AND THE STANDARDS OF BAN JOAOIAN COUNTY PUNIC HEALTH*"tMES.9MINONM ENTAL HEALTH DI"MM <br /> /. 6?E.. /_.•, CRY _HOT SIM V�� <br /> JOB ADDRESSIOR APW_ <br /> OLNNpTS NAM � ADDIEM <br /> CONTRACTOR <br /> sun CONTRACTOR AOLNE*S nPONE <br /> TYPE Of farm ISORL Nw HISTALLATION)R, moAWAvarnoN❑ DSITIIKTON(3 <br /> *ID OLFIHC SYSTEM PERMITTED E PLMJC IE1N61 IS AVAYASLE IMITHM 200 FEET OF BWLONO.) PINK:TSETIEI 1 1 HOW MANY <br /> N ASIirISaN/ <br /> II*TAYATION WILL 8INYL RESIDENCE❑ COMMERCIAL 13 OTHER 13 <br /> NANISM OP LIVNO USSTt: NUIrRt OF*m11DOEt*: WMI FMOF SMFLDY <br /> CHARACTER Of SOL TO A DEPTH Of 3 FEET: Jy�,FR/R1 M SOL CNARACTM WATER TABU OEPfIL <br /> FSSRIO TAISUOIFA*E TRAP ❑TYPEWO CAPACITY���No-COSlPMIE(f*-:� <br /> NLO TRFATMENT PLANT 13 I%*TAN6E TO IEIARIOT: WBl�9 n.-� FOUMYATION__4Z__ PMIOFt}[t'Y INI� <br /> UFT TAM"O N2E TYPE OF PUWI SAND ON SEPARATOR IDICLOSED SYSTM) L D � <br /> MUCNNt MIR CI No.•LDIOTH OF LMHES I -- A( O I ISTANCE <br /> DTO NF:-:waLj O D/_ foUNDATION PTIDPB{fY tIE <br /> RTEINM ❑WIDTH LENWH DEPTH DISTANCE TO NEAREST:WHL FOUNDATION PROPERTY RIE <br /> ❑WOTNLDQTH DEPTH DISTANCE TO NEAREST;WELL FOUMDATWU PROPERTY LIE <br /> O DEPTH/Ig�NINA� DISTANCE To NEAREST:YYFJL FIOUDOATNIN / PROPERTYUE <br /> C3wlDnl tHD LTEPTIN DISTANCE TO NEAIIlR:WB,LLpOt POIIHOATOII�PLOPSIRY tINE <br /> roN/M Q WIDTH tENOT/f DE.m+ OWTANCE TO NEAIEtT:WBL_ POLIPIOA7IDM MOPMRY LME <br /> I HEREtV CERTIFY THAT I HAVE HEMMED TNS APPLJCATION AND TMT THE NOAC WRL BE DONE M:ICCO#XUL%"WITH SAN JOAOURI CONROY CIOMANCE*AND STATE LAWS,AND ARES <br /> AND REGULATION&OF THE BAN JOAQUIN COWRY.HOME OWNER OR LICENSED AOEER'S SNNATUAE CFSRIITNTIEPOTJOTMSM *1 CSIRIPVTIMTMTHE FeIFOIBAAMCE OFTHE WOISL roIUWNCN V <br /> THIS PERMR IS ISWJEO,1 NNHALL NOT EMPLOY ANY PERSON N SUCH A MMSER AS To BECOME SUBJECT TO IAIORCIAAWS COBI9MATDN LAWS OF CALIFORNIA.' CONTRACTOR'*HMO OR <br /> SUS•CONTRACTINO SISNATUIIE C91TE9ES THE FOLLOMANO:'I CERTIFY THAT N THE PEROR LANCE OF M VMW POR YPFRICN IN*POSIT IS ISSUED,1 iMLL DAPLOY mm"*UIJE6'T TO (� <br /> AIDWMAN'S COMPENSATION LAMA <br /> �O),F CCA,UUFO'RtNA/.• THE APPUCANT MUST CALL Sr HOURS N ADVANCE FO/R//AAILL 0151141101131NMPICTIONS. COMPUTE ORAWINO BELOW. J/�, ,'1 <br /> Tiflf: OATH: <br /> 1 PLOT WAN DRAW TO SCAL15 SCALE b <br /> 1.NAMES OF STREETS OR MADS NEAREST TO OR BOUNDOM THE PROPERTY. A.LOCATION OF HOUSE SEWADE OISPO*AL SYSTEM OR PIOI'Ofl® <br /> 2. OUTLINE OF THE PROPERTY,WITH OVAETNSHOMS APO NORTH DIRECTION. -EXPANSION OF SEWASE OMFOSAL SYSTDM. <br /> N,EHO <br /> 7.DNNONm oUTuNES ALOCATION Of ALL EXWTMO AND FPOPOSED STTSICTUIES, S.LOCATION OF WELL*VINTNER RADIUS OF ONE IL�FIFTY FT.ON <br /> III"DOG COVpED AREAS SUCH AS PAT".ORPAWAY*.AND WALK&. THE PROPERTY OR ADJOSSO PF43M V- � <br /> - .......... ...... <br /> ..... ........ ... ....... ...... .- ...... <br /> - <br /> .. ................ <br /> PAYMENT <br /> ..... .:... .... <br /> RECEIVED - - <br /> ... ....... <br /> .... ....:. .......... .. <br /> JUN-14..995..:...... ...... ...... Q <br /> $7CW.JUT+L'i;3ily UUIJN1y` ....• . <br /> iPFill IC'I IMTH SERVICES ,_.._..,.. <br /> :....J�.:.. E <br /> .. ENVUtQNhtENrAL HEA <br /> .......... . . . . : . `. _ .......... <br /> ... ...€ ...--- <br /> :....:... .:._ .. ....:...:.....;.... ;. ........... <br /> I V �2 N11 y <br /> SPP <br /> :..... �__`....:.. i....._.... J:.....l..t:. <br /> / .... .. ..... .`r-... <br /> PON OBAPITES®?LYt ONLY gyp/ <br /> APPIICATLON ACCEPTIT BY U v I /\.1? D. <br /> TMC,PR OR BUMP WSPECTION BY DATE r t FINAL SgPBCTON BY OATI`_/ <br /> ADORIONAL CO1JM04TS' <br /> ACCOU4TSPO OM.Y: ADI FACS <br /> PI OODE RIES INN AMOUNT RINITT® CNBC AIH RFOHY®SY DATE OR I PEFMIT IRMM IN loll/ <br /> 42-11 140 4 11q, <br /> 00 2 <br />