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c � PUCAtIUN FOR IIUUIU WASTEtf fAwQ144wj0 <br /> �j ��5 N l0A�i111J CUt#NTP;F'1! 44C HEALTH SEBT���(($�� T ! , <br /> -� y �;.,� .t3� &I�Y1Ri44dM1P'#T I, 444TH DIVISION N;) . ��i- 3 'F �Cl�1Tr4f' <br /> tax- :� E 'r w� i t r�vmov�, rrl <br /> ��ng! +Ins-S�E2n L A 'ttt''fSp,��t� <br /> ojeomptaid to Triplicate)*`�?� � sem+' q�_tiitift3fiili�tli_i:!'ENh11T t____%PI�+ES_rt t+Cllq_Fftll�ll 'U�7E iS5lIECt j <br /> � V-fu1A[lE'fD TIkE SAN JOA(YJNN COUNTY F[l!1 A!'£KILT <br /> To CONSTRIIf-T AND10R INSTALL INE wUfiK DESCRIBED. THIS AF'Pt1CATION IS MADE IN COMI'l IAHCf Willi 6ATJ <br /> aICAIWII 111N CO TY DEVEI.OPMkTt TITi.£.CIIAPT ER 8=11 10.3 ANU IHE 61 ANOARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, MENTAL HEALTIi DIVISION <br /> Gi:.0/l""� � <br /> ckl r L?In... f.•' Yt.. <br /> AITDRF 6Rlilll RPNV­­_. <br /> lF.n'B NAE4F /moi]...... ..l�C..e..._,___.__ _ ,�y � �"���.X_ � �----'j-L..__—_�. ID! ___._.-_.._...-./.. --• <br /> - nnnfiL ss.___._S 11._�._._..._ L1 _ ..._ •q�l. <br /> I Y'I TACT(Yli .� 6_:Y_L_-1•-- !}I'-....._. 1 - ._. <br /> p <br /> ..._.._. --n-•s UEe Trlll[: IR <br /> YN <br /> � pEPrIRtA�s[+iC.a <br />'E OF SEPIM WORK: 14M MATAi I.AflOfi 1 FERC TEWT1.1 I 1 <br /> 1 Sf PCIC SYSTEM PF FlM17"TkU iF Fit lltk IC 5FYn,I141S AV All ARI r Vw t'HIFI 2UO FEk'k Of 71t11LT}kT kfi.l . _-_Y_--- <br /> NUN <br /> I 1 SSf:',I".I;. /-i JI'!i•fi �,}�T/K..9!t �G`t{yG��-^� <br /> ai,;x <br /> -- <br /> t'II1:il1h4P 01, ialt -4T ii1 J <br /> i,.,l+d.14 ft U. •d:': I. f i, .:i„1 I,t o l -- - [I, •4t�11 AHI,h4E fiT �..._,..�. --.___--. <br /> 0iRF A1P:41-'J1 Y1.11Ji I 1 Diff I evw'$1U IiL-146f: ..._.- --•- :. ~ <br /> LIFT STATION L.J SIZE— TYPE OF P1J117FP_ _SAND OIL SET'ARAT'OFi iENCIDSED SYSTEM) <br /> FiFOUNDATIONIOPE1i'TY LINE N <br /> 616TAHCE TO NEAREST:WELL.-- _P <br />!ACHING LINE ❑ NO.a I.ENGTN OF LINER -- ,; FnUNOATION PROPERTY LINE _ W <br /> LTE:R TIED <br /> ❑WIOTN LENGTH PEPF!!—_-_.__DISTANCE TR N@AREST':WELL U' <br /> ©WIOTH IENGlH _DEPTH OISTANCE TO NEAREST:WELL-.�. <br /> FUtItkDAT iON PROPERTY N <br /> EEPAGEO 1 - FOUNDATION! PROPERTY LINE <br /> EEPAOE pTb �J DEPTH 612E Nl1MtsER_ DISTANCE TO NEAREST:WELL ATION PROPERTY LINE. 411 <br /> LENG111 �� PE PTI{ /r> __. DISTANCE TO NEAREST:WEL <br /> UM Pi WIDTN .. �----- .: <br />.ISPOSAL POND$ E)MOT H t-ENOTH___y__,_-.-,-.,DEPTH_„'__ <br /> DISTANCE TO NEAREST:WELL. FOUNDATION—PROPERTY UNE_ C. <br /> HEREBY CERTIFY THAT 1 RAVE PREPARED T1i1S APPLICATION AND THAT THE WOfrl WILL BE GONE IN ACCORDANCE WITH SAN JOAOUIF COUNTY ORDINANCES AND STATE LAWS,AND RULES <br />;II 6 EGIiLT111ONS OF fI SHALL NOT EMPLOY A.HOME <br /> ON IN SUCH ICEKSEO MANNER AGE <br /> TO N THE PE.BECOME SUBJECT TO WORKMAN'S ICOMPENSAT ON LAWS OF AUFOYTHAT IN THE RN ANCCONTIRACTOR'8 HIRING IOil <br /> S 15 <br /> fK FOR WHICH <br /> juB-CO AN'S COMPENSAGNAIUFIE TION QN UIWCERTIFIES <br /> �j Of CAl IFOFTHIA.'WTi E.AP/PU�CAHH MUST FY THAT f CALL 24 ILOTAI iN ADVANCE FIFORMANCE Of THE FON ALL REQIU1REpTHi1iPECTITONg IT IS ICOMPLETE SSUED,I HDRAWING BELOWALL EMPLOY . SUBJECT TO <br /> NOWf <br /> DATE: <br /> 117 <br /> l-ITIS: �7� »----"' - —._--_.----- <br /> ..r--.._.............__.._ <br /> ._...--- lll��1 111 <br /> ib <br /> Mi 1001AW'1'0 i:C.AI-L1 <br /> 4. LOCATION OF 1{OH�3E SF.WAOE D1611OBAL SYSTEM Olt f'!t(}I'ITSED <br /> 4, NnP.4FS UP:�I ttl ka f.1311 EiTiA115 fJFARE <br /> Si 70('iR Uhl RlfltilG EHF I'tl[YI'FfllY, GJ(PANSIOH 00:EIWA!I£DI81'UIIAL SYSTEMS. <br />:2, nI1TlED£OF TILL t93OiYHIY.WifH UIMI Fi StONS AND tJOftlli i4If kt;T"tj. t 6. LOCATION OF WELLS WITHIN RADIUS OF ONE IILINOWD FIFTY f'1.Otl <br /> 7. UUdt,1191RFIE13 OUI LIN!'S A.tit)LOCAI IDN OF AE.L£x16 NNd AND F�u;liT',FD FlIlUC'iIJURft6, THE PROPERTY OR ADJOINING p1�PEFITY. -- <br /> glflUlIING COVEALD A!(EAS SlIC11 AS f AII08,1111iVEWAYS,AND WALKS. <br /> PIL <br /> C <br /> `� <br /> w. r y�1� lY< i [1i. Qu .rcwA� <br /> On <br /> d <br /> 4 , <br /> - <br /> L: <br /> Il <br /> FOP DEPARTMENT ufHE ONLY <br /> HATE:_ AREA: <br /> f,PfM1CATIONACCFPfTD$Y C .r a� 9� <br /> ,I DATE�..,�� <br /> 1 ANK,FIT'OR&UMI'INSPE("TION IIY�._^;-�_ DM1E_ I FINAL INSPECTION BY_ <br /> 47 <br /> / 6 <br /> ADDITIONAL COMMENTS: LTY-1.�..�3�1 —�"�"' <br /> - AID/ TACX -_ _ -- -- - <br /> ACCOUNTING ONLY: <br /> _HECK/ AGH RECEIVED BY PATE 8LT 1 PERMIT NUMBER ! INVOICE! <br /> E CODE FEE 11iF0 AMOLIN'1 REMITTED <br /> .- __ <br />