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APPUCATION FOR Liam WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 <br />OCIN0 <br />OWNER MANE <br />JOS ADOPESTUOR AMP 14" 71-ç? YT-iZ crrv TVCt <br />rAJo v LI- L.1 CA_ ADDRESS 1-4r71:7 e?c-ec.42 rfZ6L. <br />aoc) N, tz,i (so 4" ele, mos- (I (i4(0 -96,01 CONTRACTOR PCKV-v• 1”, A- So ADORERS <br />sue coNTAACTOR ADDRESS IJCIF F44041E <br />Type of ionic Rom: NEW riss7AuAnoN U RIP51IVE.00070N 1P4i. DESTRUCTION 0) <br />Ifro REPT= EifTEM reFaurrrro O pvauc BeAFFI43.0 AVAILABLE wrnort 200 FEET 01.151.1141211NOF <br />witTIULATIoN RILL SERVE RESIDENCE 6. COMMERCIAL. 0 OTHER <br />NUMBER Of tRANO MT* I NUMBER of BEDRooNil- NuMBER Of 116.4PLOYEE4. <br />CHARACTER OF EOM TO A DEPTH OF 3 FEET: PITTSOMP SOIL CHARACTER. WATER TABLE DEPTH <br />SEPTIC TANIDORF_ASE TRAP 0 TYPE/1.4E0 CAPACITY <br />wo IEDIATMENT PLANT 0 DISTANCE To NEAREST: WELL FOUNDATION PROPERTY UNE <br />LEFT STATION 0 512E TYPE OF pin* 8000 011 SEPARATOR ENCLOSED SYSTEM <br />Ck I <br />MEDI NED <br />"VC NO. • LAMM Of UNES 12 N - /00 ' <br />0 WIDTH LENGTH DomorPTI4 <br />DIRTANcE To NEAREST: WELL <br /> <br />DISTANCE To NEAREST: WELL <br />. <br />fouNDATiof4 <br />FOUNDATION (PC 1 PROPERTY UT.E <br />PROPERTY UNE <br />MACHIN* UNE <br />MOUNDED <br />ImEITACE 1476 <br />0 WIOTH <br />0 DEPTH <br />LENOTN <br />etzE Nprvn4tn.411ER <br />DISTANCE TO NEAREST, WEI1 <br /> <br />DISTANCE 70 NEAREST) WELL FOUNDATION <br />FM-MATO:IN PROPERTY LIME <br /> PRDPENTry USE <br />El worw LE140711 biSTANCE TO NEAREST: WE'LL IMPS FoUNOATION PROPERTY LP* <br />046110•Al PONDS 0 PAWN LENGTH DEPTH DISTANCE TO NEAFETT: WELL FoUNDATION PPOPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPAftED NAB APPLICATION AND THAT THE WORT vAEL BE 001* 54 ACCORDANCE WITH BAN AumovN COLONY ORDINANCES AND STATE LAWN. AND RULES <br />NIDATARRATIONS OF THE GAN JOAQUIN COUNTY NONE OWNER oRIECENNED AOENT* SIONATuRE cUITIFIES THE fouuDWINCE. TICERTIFYTHAT NTH! pERFANIMANCE OF THE YVCIAK FOR moon <br />THIS PENEIT II MUM I INHALE NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMpENTIATION LAWN OF CAUFORMAT °DETRACTOR'S MIRING OR <br />603.CONTPACTING 51GNIJYN CERTIFIES THE FOLLOWINO• CERTIFY THAT IN 71* PERHIRMANCE OF THE WORE FOR WHICH THIS PERFATT MOVED. I SHALL EMPLOY PERSONS SUBJECT TO <br />WORKMAN'S COFA LAWS OF CAUFORNI ITN APPLICANT Most CAU. 24 NOUNIII ADVANCE FOR ALL REWIRED INSPECTION.. COMPLETE DRAWING BELOW. <br />DATE 61V <br />111011-REFIADABLE PERMIT EXPIRES t YEAR FROM DATE ISSUED <br />frompieta ls Triplisatol <br />APPLICAT/ON IS FERRO MADE TO THE RAN JOAQUIN coutrn1 FOR A PERMIT TO CONI(TrucT ANDKOR INSTALL THE WORK DESCRIBED, THIN APFLICATION 16 MACE IN coMPUANCE WON IAN <br />JOAOUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9-1110.3 AHD TH STANDARDS OF SAN J.DA0v64 COUNTY pusuc HEALTH BERMES. ENVIRONMENTAL HEALTH 01V1830N. <br />DOT SUE 1 2- 144:_y <br />PHONE <br />PIRD MTN) I ) NOW MANY <br />444/11e44144 • <br />NO. COMPARTMENTS <br />SIONED % c.r( TRUE: <br />ATTUCATITIN ACCEPTED BY <br />TANK, PIT OR SUMP INSPECTION By <br />PLOT PLAN -DRAW TO SCALE/ SCALE <br />NAMES Of STREETs OR ROADS NEAREsT TO OR BOUNDIND TT* PROPERTY. <br />OUTUNE of THE PROPERTY. WITH DIMENSIONS AND NORTH DEIECTION. <br />DINIENRITOPIED OMTUNES AND LOCATION OF AU. FEOITINO AND PRopOtE0 STRUCTURES, <br />INCLUDE/0 COVERED MEAN IRPCH AN PATIOS. ORivEWAYS, APID WALKS. <br />So/17777.: - <br />G (7Adt'S7)75tIr ti 0PILY <br />11, • <br />DATE I 1 FINAL INSPECTION BY WOW <br />).1.4F-.14.4.,• 4, LOC ATION Of *DUBE SEWAGE DISPOSAL ayirrEla OPT PROPOSED <br />bET , ExpANENoN OF vervAoR DISPOSAL SYSTEMS. <br />r4... LOCATION Of WELL! OF ONE HUNDRED FIFTY FT. oN <br />THE PROPERTY OR AD'o.ad • <br />t <br />DATE <br />GAIME to 1.PEAA1- <br />ARE <br />DATE 6p P31,17 <br />ADDITIONAL COMMENTS, <br />ACCEPENT010 ONLY: AIDE FACE <br />YE CODE FIX INFO _E.t./1H 17 SA 1 MEW MAIM INVO7CE A <br />4). it ti c <br />AN4OuNT 1.75 <br />1 5---- / / 3 3/ <br />LPIEc71LY <br />"--7 (7/q 7 (23 , c- kf,-..i <br />Pub. Seeith Serv. - Enviro. 174