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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOLHN COUNTY/�'UBUC HEALTH SERVICES <br /> / ENVIRONMENtAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 85202 <br /> (209)4683420 <br /> NON•NEFUNDAILE PEREfT WWI t TEAN FROM DATE ISSUED <br /> IC*NI*bts b Te1FNMes1 <br /> AFRICATION Cl HFIEOY MAO!TO THE SAN JOAOIISF COUNTV PON A MAMIT TO Cd/fT1UCT ANDOR INSTALL THE WORK DESCRSED. TIES AMUCATION N MAD!N CONFUANG!WITN'SAH <br /> JOAOUN OOIRDY DMLOFNEMTTruEEE.cNAr O1 Y-111110.3 MHE O TSTT� 1(__'JC. <br /> OFF EMI JOAaM COUK"PPUBM HEALTH SUMCES/.ENVRO^NMOITAL HEALTH O <br /> nJM—m- <br /> JON ADORESWOR A^HF /^ 7 ll L— L• W/P ('JC. 1� / <br /> _ �Lcm �/Ni/C!Y �..�i- tor mu . <br /> OWMFR•*NAME rJ7� ,F'G�1L?�—� AODIRSS �SA/111S-Z' <br /> corTrRACTOR ,[�j_S� ���7�7�LS ADDIEu��7 N. W/LSon/ GCJY UCPR/nrx�I/ Rb'� 7 <br /> MIS CONTRACTOR ADDRESS LIC/ rHORA <br /> TYFE OF�%MOR[! NEW N*TALLATOM❑ NSlFANIADDITION DSSITUCTMIN❑ <br /> OIO SEPTIC SYSTEM PEMATTED F FVU}C SIEWER M AVAILNLE WAIHN 200 FEFt OF W"ANO.) PEO laiq I I WiW MNIY <br /> E,y APRE�SFw S_ <br /> INSTALLATION Welk N - IESDEr/C\Ei CO\EAUCVLL❑ OTNFT❑ <br /> NUMSEI OF LrOM UNTS: MUYSOI OF MiOIOTIII: � �• <br /> CNARACrm OP SON,TO A DEPTH OF FEFT:,�/SUMP SOIL CIIARACTINL: E1T <br /> ATER TAW D 'L�C'e <br /> S[ITC TAMWEASE 1RAI tYPEAAO CA►ACfrY NO,LbM►ARRAMTs <br /> REG TRSATMER FIANT❑ DI*rMCE to ILSMN,*T: WELLFOUNDATION FROPRRY Loff <br /> LIFT STAms O an TYPE OF PUUP SANf1 OIL SEPARATON R/ICLDSED SYSTEM) <br /> LSACfSNO UNE K HD.X 10MIH OF LSE.LL) ��' �•g OIRANCETOWAFWSTIWELL POUNDATION_jA6j2_FTOFVfTYUNE <br /> PETW SSD ❑%W" LE MTH DEPTH DWANCi TO W,^AFST:WRI 0OI0iOAT10N PROFOfrV WE <br /> MDUbm ❑WIDTH LENGTH _DASH OISTANCE TO NEAfESr:wRL FOUNDATION RIOFOfTY LIN[ <br /> SSS►AOS PRE AO!/NEH /T�QtE �r/_NUMSM__L_OIRAMM TO NEAREST,*OnL��AUIOATION��'}PRDFORY LEW 1 i� <br /> BURSAS ❑WprN LENOrH _or"ll m*Awr To NAAIESt:wujL _FOIMUATITXI RVFERrY LJNE <br /> Comm PON" ❑WLDrHI LEHaTN _DEPTH DISTANCE TO WA EST:WELL_FDLNPDATION FRDIEIRV LM <br /> — <br /> I HERESY CFATFY THAT 1 NAVE FREPARED TMS AMMATON-ANO THAT THE WOM WILL M DOME IN ACCORDANCE WITH LAN JOAOUIN"WOrrY OMMA CU AND STATE LAWS.AND NIXED <br /> AND NOVLATMIM OF TIM SMI JOAORNM COUNTY.NOM[OWWRON UMNISED AGENT'S KONATLIPE CRRRES THE POUJDW~:'i CIEP TFY THAT W THE P19"M ANCE OF THE WORK POIIWNCN <br /> TMS PIPMT N NNIED,1MNOT OT MOLDY ANY MINION N SUCH A MM`IWIKM <br /> MM AS TO WCOME ILW)WT TO YIW.'S COLESNOIOMN <br /> SATN LANK OF CALA' COWRACTWPS HYSI S on <br /> C <br /> .USONM rRAcT 00"TUM CEIITFTES THE FOLLOM M:I CENTNY THAT IN TIE PFFVONMANC!OF TWT WOR!FO'A NMCH TMS FEFSAR N MKWD,I OWI EMPLOY PONONS SVLXICT TO M% <br /> WORLMAN's COMPIE NATION LAWA OF C A.' TM APRICNIT MUST CALL b HOURS N ADVANCE POO AU.RIMMED OMPEOTIONS. COWLET1 DRAMMID SLOW. y.n <br /> ROT PIAN DRAW TO SCALD*CALIF__*b T' <br /> 1.NNAFS OF SHEETS OR ROAD*IEAMST TO OR DOUNIMM THE ROP9frY. 4.LOCATON OF HOUSE SEWAGE OSMOMAL SYSTlEI ON FROPOGW <br /> 2.OUTRE Of TSE PROMRTY,WITH DOLRNIONs ANO MONT"DSECTON. EXPANSOH OF SEWAI E DNFOSAL SVSTMM, <br /> J. WEMMONOD OUn,046 AMO LOCATION OF ALL EXISTNO AMD FFIOROSEO SRUCTUIE► S.LOCATION OF WRIT WITHIN PAD"OF ONE M MORED FVF Y FT.ON <br /> 10K7IUOM COWED AFEM RICH M PATON,OMVEWAYS,AND WALKS. TIE AOFEFRY OR AD.MNM"OPERTY. <br /> i <br /> ...».i. ..:.....:....:...:.. .. .. .. ....:......:......e. ...... .... ... .. ...p.._..i.....:..... ......:......... ....... <br /> .. .... .:. r. ..-E.. ...;.....�.. <br /> .....: ....p. <br /> �...._�.............:. ... . ... ... <br /> F <br /> i. <br /> ...........?.......t... . E _ ygCC-6 lE..S. R o A <br /> :.... <br /> 4 Z <br /> ._... . ... ... . .... .. <br /> .. ....,. <br /> -- <br /> ?1. <br /> C 00USE <br /> r S. P i 4198, <br /> -�, <br /> .. <br /> ... <br /> EhTH»MVNCFS <br /> .. .fALFJE'ALTi1 mwil, <br /> LS/iCIL LININ [p.) 1� POI)D*�/fTMBfT /-yf �T <br /> APRICATON KCem FD SY • ` V DAT): �� • MFA: O�I <br /> 7ANC I1�Mw'Cpg1A NE CR) DATE_ ZZ. F.W*PECTDN*v OAT),-I 1'lll.1'I 11 <br /> ADOfrp rgatlav:rs: <br /> ACCOULTNO ONLY: <br /> PS CMA FHEO SAMOUFIT REAITI" ASH 11SC spew IS, M <br /> Y DATE an R EET INMMMI DPVOIGE A <br /> PUD.Hftft Sm--E—ro.174(3)0) Q�O O 110 u <br />