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APPLICATION FOR 1.109M WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES � �"C)Cr <br /> ENVIRONMENTAL HEALTH DIVISION € t <br /> 304 EAST WEBER AVENUE,STOGKTON,CA 95202 Z(alpv <br /> (2as)468-N20ROd FFIINdRdIE TER R FROM <br /> p'mwisu A Trowell <br /> APPMATION Cl WR011Y MME TO TE NAIL JOAOIIN COUMrW'FOR A PERMIT TO CONSTRUCT ANOM INSTALL THE WORK OEOCRMEO.THIS APPLICATION M NUDE M COMPUANCE WITH MAN ` <br /> T JOAOUCJ COUNTY DEVELOPMLFIT TRIM CHAPTER W 11110.33 ANO TNM OTANDAIOM OF <br /> SAN J0:M;Z NTT FUDLX HSLLTH SE-,a. <br /> VICER AL NMALTH OIIAMON, <br /> JOS AOOFIESEIOA AM* L/J__ �T ./W_ T.- C/TY�,�, �� —LOT4- <br /> A-' �•/�¢y1LEs <br /> OWHLR's NAm odlm •G/W I /f AGGRESS _ _ _ rRpm� <br /> L4NRRACTOP�/!.11Y7a71r1 . lam,., .-C ASOPES6/r•! •l'� r H �77]WRITHE ?"[3 <br /> BUS CONTRALTOLIC. NM1NE f <br /> TYPE OF[RTIC ISO M: NEWM INSTA www O TRPANIADOITIO SpTRIETIOM O <br /> OM SEPTIC EYSrtM FEMWITEO IF PUBLIC 6lVY[M IS AVAOAMEE AYITNM 20D FELT OF COHOST PRO TEITM L lNOW NILNY <br /> : AF//atleA• <br /> L ttt WSTALLAIOWILL seR! TEtLCOMMERAD oTER O <br /> NISSIA OP LIVING;Ms: <br /> NLI N M OF TEMPLdYm: ' <br /> CH AL•TEI OF[ORYO A DEPTH OF SIN PTISULIP BOIL MARACM_WATER TASTE OFPE L <br /> Sano TANNIof[NB TRAP 13TYP[IMFO CAPACITY NO.COMPARTREDWS <br /> FICO TREAmmr FIANT O.PBTAROE TO NEAREBT: WELL rOVIDATON POPExIYw! <br /> { OFT STATION 13 BRE TYPE OF PUMP O4 69%RATON E.NCLOBW 5YUTDAI <br /> WCNm IME �NO.S L@iOTH OF UNEe a�_ �_ dSTANGE TO MCAIE[r,Y1E ' <br /> �. �^/�- L FOUNOATIOH/a PROrERTY TME <br /> RLTRI aR O WIDTH LENGTH DEPTH DWAHM TO HEARER!WN LL FOUNDATON rROFERTY UNE <br /> NOIAIO® ❑VMTN LDDMTN OATH DISTANCE TO NFJYEST!WELL POUNDATION PROPERTY LINE <br /> SWAOfPRS 17 DEPTH SIZE__NUIARDORSTANCETOWEAfEWrlVALL WNIIOATON r"NOWYL/NE <br /> CISNrs 13 LYNrM LENGTH OEPTH ORSTAME TO NFAME[TI WELL_—FOUNDAVMPROPFIPTY LWE <br /> OIMOSAL FONDS 13 wamt..LLNOTH oEPrH wwrAME TO NEAREST;WELL_POUNOATION FROPIM V UNE.- <br /> 1 HERMY CERTIFY THAT 1 HAVE PEPAFItD TNa APPLICATION AND TMT THE MARK WILL OE DOTE IN ACCORDANCE O[T"BAN JOAOIIW COUNTI'ORDINANCES AND STATE LAM.AND IWIB <br /> ANO PMBU OPTH[BAMIOAOIRNCOWNRY.NO OMMEIOn1ICQTS[D AGENT'S StlIfIRU16CFRRSiEOT11E FOLTDPIMOt'ICETRtiYTXATMTM�OTMWICl GP77E WDIM({pRYTLMCII <br /> TNN M .I aHALL iOT DAPLOY ANY N SUCH A MAKER AE TO BECOME SUBJWTTO VJUfKMAWG COMPENMATION tAW'O OF CALW*f*MM'CONFRACTOIfB MRIs OR _ <br /> rtRllcnr TORE THE :'1 CERTIFY THAT IN THE PEKORMANCE OF THE WOM FOR1009m TMC PEPOW IS ISSUED.I WALL EMPLOY PUMNO 10106 CT TO <br /> 7 <br /> 's 00 a CAUPOIW MUST CALL 24 lout In AWAL(�.a0 MOUMSA SIRSOT".COMP{ETESRuvm BELOW. <br /> TIRE: . ORTE: <br /> 1 P1117 RUIN{�T4 MCMf>KALE _•b <br /> 1.""m OF I TLEETB 011 ROAM NlA11EST TO ON TOUNOWB T.I,L�E F�ROMOU <br /> M- - 4.LOCATION OF HR SEWAGE 019POM CTFTEM ON PROPOSED <br /> 2.OVTUIE OF THE <br /> PLOPENTY.WITH DILIENSRTNS DI <br /> ANO NORTH RCTON. E=1 ATMON OF w MfAQE DISPOBAL MYSTEMS. <br /> O,DWADWONEO OGt►WEs AJO LOCATION OF ALL EIMOTND AND PROPOSED FTALICTWE6, S.LOCATOR OF V110"WITHIN RNXM OF ONE MNDFIM FIFTY FT.ON <br /> tNCLUDIN6 COV[FfD AIMJLB SUCH AS PATID%DRIVEWAYS.AND WALKS. TILE FFJMW OR ADJOO[ND PROMITY, <br /> -. ,SSSS. . .y....... ........ . .. .. .. _ SSSS <br /> ......;......6.....o.....:..._i...SSSS....;...:SSSS,.. ...��„..••• ... ....,,. .. <br /> - .. .. . . SSSS.. .. ... ... <br /> . '....i ...,SSSS:... --- SSSS.,, - <br /> .......:....:... ...;. .. . ....< ...:�s7 .�� .,.,SSSS SSSS ' <br /> .L ^,. .. ... SSSS. <br /> 7171- J. <br /> .. .. SSSS-M, .. ..i....:. <br /> . �......................................SSSS SSSS.. . .. ... SSSS... .. ..... SSSS... SSSS-. <br /> :. SSSS ' .`. SSSS• <br /> � -._.. -... �- SSSS.. SSSS ... . ......�."?d. ��' <br /> �..�. ” SSSS. <br /> .. . ..�....;SSSS <br /> .... <br /> Qo. <br /> y <br /> 1 ......;. <br /> 1 SSSS. <br /> . .i .. . .... s....... .. r <br /> � . <br /> SSSS. <br /> . SSSS... <br /> : <br /> ... .. ... .. . .. ... .. . SSSS... <br /> . <br /> : <br /> SSSS.. . .. .......... .. w�::.lc.; SSSS . .:.. <br /> SSSS._ SSSS ,.. 1 , ........ <br /> .. ._........ ........ _ .. . . ...........<... ... SSSS_... <br /> EEyy��LAMM� .......... ...,.. <br /> l ...... ...... ......:._.. Y F 8 <br /> SAjj <br /> :SSSS . .... ......... .. ... ... ; <br /> ..............SSSS°SSSS:. ., .�. . .. ........... . . <br /> SSSS .. <br /> SSSS.. <br /> � ......... .............:..... ...... ..: . . ..........:....:.... .. .......°.....:.......; .._:.....`...... - <br /> - FOR DVAPTMERT YM[OIRY <br /> i APP ICAT10N Ace ET m BY DATE; / O /MFA: L 19 <br /> TAMC.ITT OR BUMF MTTECNDN BY RNRTE�_ ! FOCAL I DATE�.� J1 <br /> ADDITIONAL CO MMIT$; . <br /> ACeauNTRIO ONLY! AID; FAcf ' <br /> 1 TEeOUE Fp LIIPO ;MOUNT NLLNIT[D ASN I RN EMD BY DATE SR IMWAIT NIMR WVgcer <br /> L �fz4 S Ili 0-9/40 a IGO <br /> Gi92I k7 <br /> Pub.iWBhh San.-EMftO 174(3188) <br />