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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOENVIRONMENTAL HESERVICES <br /> HEALTH DIVISION <br /> S�pT <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 85202 <br /> (209)468-3420 <br /> 1901-REFUNDABLE PERMIT EXPIRESYI EAR FROM DATE ISBDED <br /> R)nOPbte in Tt*rmatW <br /> APPLICATION 10 HERESY MADE TO TIE SAN JOAGUN COUNTY FOR A PES.AIT TO CONSTRUCT ANDAR INSTALL THE WORK DESCRBED. TH_TrnAI ATUCA AOM IN COMPIANCE WITH BAN <br /> JOAOLR N COUNIY DEVELOPMENT TITLE. R 8-11 70.3 AND T,+1H�ESTANOARDIR KOF SAN JOAOUIN COUNTY PUBLIC XFAETN aEAVIC[M. OINf10N. <br /> Joe AOOSALTR M'IIF `^+���/" "` f T WE <br /> FE2��� <br /> y -T crry <br /> OY"M'S NAME�(?� r l��i AWRESS LI,FNO <br /> CONTRACTOR ADDRESS 11LP RM'w <br /> SUBCONTRACTOR ADDRESS UCI RHONE <br /> "PE OF"PTV WORT: NEW INSTALLATION❑ IIOASUAOM OSei111IClTON❑ <br /> ENO SEEM RJWMFD F PTIC PC11UC SEWER R WI <br /> AVAILABLE THN 700 FE[T O NKL I PRC TL3TN11 1 WOW MAMY <br /> AvOWd— <br /> INSTALAAnoN HMILLSSRvc WeC E❑ COMMERCIAL OTxfR❑ <br /> NUMBER OF LV O L"TS: NUA►91 OF SSOPIPMS: RRM61 OF SMRAYEl3: <br /> CRARACTER OF BOl TO A OET•FH OF 0 FEET:_ PTSIDAP SOIL CHARACTERS WATER TABLE DEI"{__ <br /> SEREC TANRIORSAfS TMP ElTYPEwm CAPACITI' NO.COMPARTA*WtG <br /> FRS TREITIRMT PART Cl DISTANCE TO NEIWATT: WELL FOUNDATIOX PROPERTY LNE— <br /> LIFT STATION❑ M�� M <br /> Zf TYPE OF PUP SAND OIL SEPARATOR ENCLOSED SYETEW /__ <br /> LIACIMO UNE /�7I•� NO.S LENGTH OF U NCf , <br /> pISTAN[E TO NEAJEET:WELL 00 FOURR'ATON PPOI4RTY LINE <br /> ALTER PEO ❑WIDTN LENOTH_ DEPTH DISTANCE TO NEAREST:WELLFC AAOATIDN PRDFCMTY UK <br /> MOENOED ❑t-I WDTM LENGTH_DEPTH DISTANCE Ul TO NEAREST WEFMNDATION PROPERTY WE <br /> E R <br /> SEOAOTS LJ DEPTH SIZE _MIMaEA d6FANCE TO NFAPEST:WNL FOLINOATION PROPERTY LNF <br /> SLEAPf ❑-I MCT" LtNW H _DEPTN DISTANCE TO NEAREST:WELL _POIMOATWff PRDPEMV LINE <br /> ORIPOSAL POW# CI WLDTEL DEFMTH DEPTH DISTANCE TO WAIEST:WELL__FOUNDATION PROPERTY UNE <br /> 1 HERESY CERTIFY THAT}MK PEPAAW THIS APPLICATION AND THAT THE WORK WILL BE DONEN ACCOIb1VlCE WITH SAN JOADIEN COUNTY ORONAMC[B AND RATE LAWS.AND RULES <br /> AND MOULATUNB OF THE SNL JOAOUN COUNTY.NOME OWNEROALICET.7SIGNATURE AGENT'S ONATURE CURWRM THE FOLL&AIR:'ICU"WY THAT N THE PERFORMANCE OF THE WORK POR IA&W" <br /> Two PERT P ISWIED•I SHALL NOT EMPLOY ANY VEISON N KRDH A MANNA M TO WOOME SULIECT TO WORUANft COW44"ATION LAMS OF CALIORMA•CONTRACTOR'S W04 OR <br /> 'UO'CONTRACTNG MONATURE CMVES THE FOLLOWMO:'t CERTIFY THAIN THE PE/FORIAANCE OF THE WORK FCA WHICH THIS PEIMOT IS IBMD•1 WIALL DAPLOY PF1100119 SUSIECT TO <br /> WOR KMAN'a COMPS TON OF CAII/ORMA' THE AST t.ALL H/OISIS IN ADVANCE I'OR Ali IIEOUSIIm SNSPNC.7IONS.C01lltFE ORA,MNO bELDW. <br /> IJ/SL /, r{ /- <br /> v <br /> ISMED k��-If._. �7 1 TREE:_ 1 W !V <br /> ROT PUW MRAW TO SCALE)SCALE <br /> 1.NAMES OF STRUT$OR ROADS KAREST TO ON SOMMNO TTE PROPERTY. IP4.LOCATION OF NOUN SEWAOE DISPO►AL WMEM OR PFOPOSED _ 1 <br /> 2. <br /> OUTLINE OF THE PROPERTY.WITH IMl <br /> N ONMDN1 AND NORIA DIRECTION. EkPAMSIOM OF SEWAGE DISPOSAL SYSTEMS. V <br /> J.OSAEH>tONEO OHITLSES AND LOCATION OF ALL EOSTNO AND PROPOSED STRUCTURES, G.LOCATION OF WELD WrrHN RADIUS OF Did IRSdED FIFTY FT.ON <br /> RNCLUOEPO CO%MftO AREAS SUCH AS PATIOS.ORVEWAYS,AM WALKS. THE PIOPRTY 011 AD.DSENO POf41TFY <br /> ...............: ... .. . ..... .. <br /> • ...1� l o�d . <br /> :...:. ... ..:. .:. . . . ..:................a. .. <br /> s. <br /> .... .............. ... .. <br /> • <br /> : ......... <br /> ty <br /> :. ... . <br /> ,IOU 2 9% <br /> :. . .....�_.�.-� ....... .. 1 <br /> �'t� <br /> 1CFO1l l7BART VK ONLY I <br /> AINATpN ACCEPTED DY i l✓,LM�-/// VSA,` F OATS: <br /> TAM,PT OR SUMP INSPECTION BY DATE f f FINAL INSPECTION EY DATE. <br /> ADDITIONAL COMWftb: <br /> ACCOUNTSHO OILY: AIDS fACS <br /> Pr COOS FEY INFO AMOONi ROAR-TD NEC ICMR RIMEV®■Y DATE SR i PI SAT NIEABISL INVOIGEI <br /> _-- <br /> � z <br /> Pub.Health Se -EwrC-174(3) 6) <br />