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APPLICATION FOR LIQUID WASTE PERMIT //, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES AW ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (208)468-3420 7(IJ 909•REFUNDASLE PERMIT EXF"ES I YEAR FROM DATE ISSUED (Comp1PSS i TFIVImt.) ArKXATR)N N HEFESY MADE 70 THE SAW JOAOUN COUNTY TOR A PFRWT TO CONNFryCT NADMIl INSTALL THE WOW DESCRIBED.THIS NRCATION 1/MADE N COWLIAMM WITH SAN JOAQLM COUNTY DMIOPLMWT TITLE.CHAPTER 5.1110.3THE STOF/AN JOAOUN UHTY PVRIC N[AL7'N SERVN�S,8/VIFIOMSDfTAL HNIEAIiH`/ryy(� �� JOS ADORLSDOR.W1. !' O ` .e CITY31w_" ,T M�12�v�/�'T 01NNQ1'i NAME//�YY�D,,11'S L-L). - A... `K �� `• `�-7 "^^�� R CONTRACITIR�T�.I LJN ��i�-�',c.� AODREBB � E. •� uC. Zv ENOS�E SVS CONTRACTOR ADOIESS UCI rINOFE "M OF.vT1O MOVIE: mm IMTALLAYIOw RLiNRAOO1nOM❑ DESTRUCTION❑ NO SEPTIC MST W PESAITTEO IFFMR1C SEWER IS AVAAASLE NnTHN 200 FEET OF BUILDING.) F11C TOTNI 1 1 wm MANY A),FSo.NR I_ NSTALLAnow WEL marm RESiDITICE❑ COMNEIICNLL))L OTTER❑ 1! NU IMIR OF LIVING UIStS: NUKLIM OF SmUBEI OF BARO ROOMS: NMJ 1 OF SOL TO A OEPTH OF 2 F" DCL L RAL, d4 PIT AIP SOL 7E1 TAKE O[FIX I tAM TIIIV ❑7T'1'EMC-0 CAPACITY�/A Pte(/ NO.COMPANTMdTS .� RANT❑ ON TANCE TO NEA ST: WELL._ FOVIIOATION _�A PROPMY LINE/O© UIFT STATION❑1S.R/F TYP[OF'F,VM► SAlO Ol SEVAAAT011 IENCLOSED SYSTEM' loO A LEAGHM LINE i NO.A LENGTH OF IYKS /EJ</1/ dtfANC[TO 1t/1REN:MEI-L OO• FOUNDATION /D R10FlNFY L1FL� FILTER BID) O WIDTN LENOTH_ OEFTH DISTANCE 70 WAFMT:WELL POUFAmT10N PROPERTY LITL mowwo ❑WIDTH LENGTH__DOTH DOTANCE TO WLAFIEST:WELLPa~TION PROPENYL'LINE S®ASK PR. O OEFTH VR[__NUMEER OWANCE TO NEAREST:WELL 4OVNDATpN PFMPESTY U lNll KS/PS ❑wwriI LENGTH comm OIST)WCE TO NEAREST:WELL__POUHDATION PIOPERTY UNE twepom PONOS ❑WIOM tOWTH D[FTH DSNA&"TO NEAFtMI WELL FOUNOATIOM PMKNtYUIE ?XvwiRw T I HAV%PRPAWD TTRS APPLICATION AN THAT THE WOFR WEl EE DONE N ACCOMANC!WITH YAR JDAOUIN COUNTY OFDEWICE/AND STATE MWS.AND RULES WIIANJOAOUNCOVNTY.NOME UCETMW"VEST•SSIONATUFECEITRIESTHCFOLLWWING:•1 CETFY THAT N THEFEWORYANCE OF TMVVDFX FORISMCH ,1 SHALL NOT ANY P[MON N A MANNER AS TO WCOME SUSPECT TO WOFKMAR'S COWINSATMN LAWS O CALOM"Lk.CONTRACTOR'S M9M OR TME C IIES PaU.OWNO:h THAT IN THE FEWORMANCE OF TIE WOW FOFf VMICN THM PESTER IS ISNUED,I SWILL O.ILOY FERSOO WLECT 70 A N M F CAW NS CMT WT CALL M/IOW N ADVANOE PDX AU. ED IMUWTIONS.COAIRME pNVAM BLOW.TrnE:_yQ) ROT PLAN IOPIAW TO SCALE)SCALE 16 I.NAAms OF/TIE[Ti OG ROADS R TO OR/OUFIOINO TIE"w"'TV. 1.LOCATION O HOWE/[WAG[IONONES.SYSTEM OR PROPOSED2.OURSE OF THE RIOPEFTY.%TTN pA4NSIOFM AMD NORTH ONECTION. EIIPAMSION OF SHAW DISPOSAL SY87111NO. 7.OIMEIKONED OUTUFtS AND LOCATION OF ALL VUffTINO AND PROPOSED STFI=TtSEk, E.LOCATION O WILLS V rMN/IAPUS Of DOW IRUNDRD FIPTY FT.ON IIRUAIDIN0 COY1 1FIEM SUCH AS PATIOS,DFIVEWAYS,POND WAIAS. THE ROFEOY OR ADJOINIMII FIIDFIRITY. .. :.... ...... .... ..... ...........i......:.....e ...s. .. ... .. _ .. .. ....:.. ......i. :..- i _. .... jL ._. ... .. .. : .. . .. ..... .._... .. ....E.....d... :...-:......; ....:... j.... L ....;............ .._... _ _ j ' .................�...........b............:......�...... _ y................ .....j _ ............ <.......:.. _....:._...e.»..»......d....;......i...._..... .:.... .... .t.... .. ...........i i i e ...i......i.....4......7._ ' ......:......:......L......_.....o. ....»i.............:.............o......,_...... .z. - -- ..1......,.....:. w..>.. .! .i. : : i .. ... ......................... ....._.. .... ....... .. ............i... ..............`... L........_....i.... #..... i .. ...a ......... r.. ..1..... _........ ENT . : ...............:.....:..........._...............'.. »... : .... $£P i G 1998 ..........: e.-.... i .... J ....:L...i ... .+.Tn.;..+n.E. ..h...:..[-'gam _.......'......._..:..........ii.. ..».»........._........e .......s.....,....� i ri,,,;. fJ1YE.fPUEILIC�HEAL�µ'<%EC1Rt1fNK►JYES.... .......... . ... ...._:...'.... I. :........... .. "WNTIL HEALTH WOON ... ....... ...........:.................. _..... .... ... e � FOR OSARTYbIT USE ONLY 4 w{. //APPLICATION!ACCEPTED MY y OAT%: / AVAUL dl 117 1 At RAN.F/HT OR iUASe NSPFCTIOH BY GATE 1/ FINAL INFECTION EY ! L Mi► ADOMONAL COMwE�»: / C' G o✓ld I'o WY-✓ l-< At•r ,n-k ilj6le d ! S AEAOUNt/.O ORLY: AIDJ I.C. - PE CARPE FEE ENO ANNOUwI RUINITEO \ /CASH 11lCEVm/Y OATS SN 7lEIR7 NMA1S11 ENYOICE ff Pub.Hatltf Sem-Envlro.174(3A)6)