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APPLICATION FOR LIOUIO WASTE PERNIIT <br /> SAN JOENVIRO MENTAL HEALTH DIVISION R�CES S E PTS <br /> 304 EAST WEEDER AVENUE,STOCKTON,CA 95282 <br /> NOM p1SUROlO1F SEpF11T EY2 M9EE 1 �IN GATE I>[Mo <br /> R GpgYLB Y iRip9SOW <br /> APPUCATMM la HERESY MADE TO 1HE BAN AOAOU N COVNFY FOR A PERMR TO COMTMCT Mammon SMALL THE WORK OEM MW-TM MMCATDII b MAGE N COMA-SONGS MEFH MN <br /> JOAQUIN COUNTY OEVfED/YBA TUM CHAPTER 9/.111110.9 TIE BTANDAIOS OF SAN JDAOUW COWlY PUMIC HEALTH SEfIVIC aMONBRAL HEALTH dNSON. <br /> JOS ADMESS/OR AAJI "" 1 Crry O F �7 LOT ._T_ZA <br /> d <br /> ONRJFJI-B NAME t MORFM 4s-:9�y^�1 •• f ALONE CJ P/^7929 <br /> CONFRACTOR AOOIESS leg 7S? l--tr : UC1 Y A/OEAd -/G�l <br /> etlS CONTRACTOR ADM� F•, LLCS IO,IMIE <br /> TYPE OF BE►T1C WONN: HEW NRSiALLATIOH MII1w/AbO1TON LJ EIEBTRUCTIOH❑ HECEIVED <br /> MO SEPTIC SYSTEM PFRUMED E AMEX SEWER PS AYAAAME WTTMM 100 FEET OF MI"MI PFSIO TSSTNI(1 MOW MANY <br /> AFPSL+SPN <br /> INO,TAlLAITON WILL Sa1V£ IENDONCE❑ COMIFNCIAL14 OTHER❑ <br /> *MOOR or UWEIO MSTS: Huwal OF SSDIOGMS: NLAOa of EMPLOY=: SAN JOAQUIN GO LINTY <br /> CHARACTER OF SOIL TO A DEPTH Of 3 TEST: PITJSUMP CHARACTER: WATER TAME OM ��0IRI IC HEALTH SERVICES <br /> SSPM TANp/MCAu TRRA�PT ❑TYPE/RTO� fJNJS*E7! CAPACrtY 2 O 4� No.COMPMTSSBRS ENVIRtgMENTAL HEALTH DIVISION <br /> PES TRAATNNW AAHT IJ INSTANCE TO M AEUET: WELLFOUNDATION P"opmTYUNE <br /> Lar STATION❑ NEE TYPE OF RASP SAND OIL SEPARATOR ENCLOSED SYSTETJI <br /> LEACHING UNE ❑ NO.a LEHOTH OF LNIS !j 7 S ' OISTANCE TO NEAREST,WEU FOUNDATION �Q , fNOPERTY LRH <br /> ALTER BED ❑WOTH LENGTH DQTH OIBTANCE TO N[AREBT:WELL FOUNDATION PROPFRTY UNE <br /> motwm ❑WWN LEMSTH DNTN DFSTANCE TO NEAREST:WELL FOUNDATION PROPERTY LNF <br /> SMACK RTO, ❑nKVrH MEK NURISER DISTANCE TO HEARETF:WELLFOUNDATION FFIOPFJTTY EINE <br /> sum" ❑WLDTN4L! LOOTM�OBTN��OMTMICE TO NFANEST:WLU- p�10LRAAT/DN _fEOl6ETY llJE �� <br /> DISPOSAL PONDS []WROTH LDWTN DEPM DMFAM TO PIFA,IEST:WELL FOU"DAT"" PRIOFFRTY LSE <br /> I HEREBY CERTIFY THAT t HAVE PREPARED THIS APPLICATION AND THAT THE WORE VALL SE DONE N ACCORDANCE WITH SAN JOAOLRN COUNTY 61OIREANCES AND RATE LAWS,AND RAPES <br /> AND REOULATIONS OF TIE S.W JOACHIN COUNTY.HOME OWNER Oft LICENSED AGENT V gaNLTVRE CIA TIES THE F*LLDWN O:1 CWT WY THATSJ THIN PERFORMANCE OF THE WORK FOIL WHICH <br /> TMS PEISAR H HISU[O.1 SHALL NOT BiEDV ANY PFRSOH N SVC/A MANNER AS TO SECMUf SUMECT TO*MWA ILM'S COMMMATWO LJRYE OF CALIORSRA'CONTINCTOK0 NSSIIS OR <br /> SUS.CE NFRACTSp SONATURE CaREES THE FOLLOWNO:'1 CERTIFY THAT N THE PFP"MAN E OF THE WORK FAR WMCH TM VMW N HHR ED.1 SNML LSAPUW PM90I1SJRNMSCT TO <br /> WOIW A WS COMPENSATION LJIWS OF THE APPLICANT MUST CALL 2E HOLM Of AOVAME FOR ALL LIEGUMID COMMME NYBMIO MROW. <br /> SIONEO% -- ' "� ,�`� ,, —:2J:2 4v <br /> ROT PLAN DRAW TO SCALE SCALE •M <br /> Tt OIIpOAOS IEJIIESf TO OR SOLSDNO TIE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DtNKP AL SYSTEM OR PROPOSED <br /> t.NAMES Oi tT1EET <br /> 2.OL UNE Of THE PFIOFOEY.WTTN DINESISONS AND NORTH DIIECTDN. E%PAHSIMP Of SflMAOE DIIIOSK SYSFaAS- <br /> J.DWFNSIOMO oVMW SATO LOCATION OF ALL EXPETSD AND PROPOSED STRUCTUR0, E-LOCATION OF WELLS W"MN RAMPS OF OLE WNDPED FIFTY FT.ON <br /> INCLUDMO COyaWAMU SUCH M FATDS.DF VEWAYS.AND WAt1KB. TIE FROFOOY OR ADJUPSM F'ROPlRTY' <br /> ._. .;.....i......j..._.%r....:......i <br /> 3a�cJiPrit <br /> � .._... <br /> -4 - <br /> . _ <br /> cl �srJ�E/ <br /> 4 <br /> - <br /> :... <br /> € - <br /> q.. _... <br /> �- -- - <br /> .___..... _o.-...... ... - - - - <br /> ........... ►tak dor lflrrnrr+er riP <br /> -- <br /> � <br /> DATE. <br /> AAFA% --• <br /> APPLICATION ACCEPTED BY <br /> TANG.RF ON SUMP MSPECT101J BV <br /> DAT[ / 1 FINAL MSPECTIOH SV GATE CJ J � (tel/ <br /> Amrlw/u COMMENTS: <br /> -ry-br filTR R rN S D ra <br /> AOCOUNTINO ONLY: AID, fAGF <br /> PE CODE PEE LIFO AR"Wff N"ITSD CFISCIMK PEC@Vm W MT[ NIMR <br /> 2 R,OO <br /> Pub,HFelth SeN.-Envifo.174(3Ra) <br />