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' APPLICATION FOR LIQUID WASTE PERMIT • <br /> �AN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ' P.O.BOX 980,904 EAST WEBER AVENUE,STOCKTON,CA 95201588 <br /> I2DSI 4153420 <br /> NON-REFUNDABLE PERMIT EMPIRES 1 TERN FROM DATE ISSUED <br /> FugYb 4 Tfy&BMI <br /> NRICATION If HERBV MAGE TO TXF PAN AAq/IN COUMtY FM A VEIIMrt i0 CONHFOIECT AIpp11 NBfALL THFM•OIK IXBCIFBEO. TM{—ATION M MAGE M COMPLE-1 VATH BAN <br /> AAd/IN COUNEV OEVELOTUEENH TETEFEEE.CHAPCTE\R B-1 f 1 'J[AAM THE"AM 8 OF SAN MAQIM COUNTY FVM/C HEALTH BEENUNL118,,E/N��VR�tlMME�XT/AtyHEA�LTH d Mll <br /> .gBAD[IRFB6pRLALIT�II IEJ�V L V1)I.� rJ,�E'E✓. ' �[RV�T�R�O✓YLL&7 ✓' ✓✓fp LOTPIEE�a <br /> OWNER'S NAME R 'EyI��.(((I:J e,AdNR.. U 12 50, jjwn LAli� �• LEo�D'' El10NE3'34-37D 1• <br /> LONfMCTOR512CCO V�6 ADdIEBB E'er CLIC. 3f-A72 FRAME ✓ <br /> 6UB CONEMCTOP MXNK B HCI R1ONE <br /> TYPE OF BE)TIC WORS: Mm d{TAWIMN M ANNURANOM O OEITHKTMM❑ _ <br /> dO PfPTIC BY{EEM PERA TETO W R/BLEC 8—IB AVA-MJE UATNM ECO FEET OF MUM-0I PEIEL LFATh11 11bW MANY G <br /> AMvEen B [� <br /> IN{TALLAIMN MTl BONE: PE&OUNCE❑ COMMEISIAL❑ OPENER❑ �(��(� //�J//����((�� N <br /> NtBMiIU OF...VM TB:_MOPBOE DF.EORDDM.: NUMNM1 OF EM K..: p�l 5qy((/ l�YWiY_/v <br /> ' UHAMCWR <br /> TER OF TO A OfP1N OFE FEET. Ti/EVMP MO CHARACTER: WATERTAMUOENN <br /> fEI,IC TANNgUFASE TRY ❑TYITAUFO CAPACfTY M.COMPAATAMMP <br /> WA TNEAT .'MMT CI dfTAMC[TO NW4T: Wl1L I.,R DATpN TORRTV LME S' <br /> UF?STATEOM❑ tlU TYPE OF F E ARAM OR BEPAMTOR RNL..13,MYBEEMI <br /> i <br /> EUNE 13 q.NU1pTN Of,NNFP dBTAE10E iOFIRMEST:WftL_FOUNUATTINN TOE[IRY THE <br /> FLT..O ❑TNOTN UVAITH OfPN d1ANCE TO H <br /> EARS :WELL M1MATpN Y <br /> P110RIT'TEAM- <br /> 11 UR,HH <br /> ME❑WIDTH UNOTN MMN�d.TANLE TO NEARFBi:WELL fO11NOYpN_rrTtlRMN� 'vT <br /> B[FDAOf ,/ 11 MPM SEE MANIR�ENREAHCE tO NEARrtWE <br /> E : LL FOUNOATN)N "';Q O1VUNE <br /> {UMM ❑WIDTH U.TN .FIH�DI.TANCE TO NEAREST:WELL�..AT..' lie RQFEpY.I/NfT dfro{AL FONDS ❑WIDTH UNOTN OFPEN drtAHCE TO NEAREST' VL IRp1PA1OY�T`TTIFE-'"�� <br /> 1 NFREBY CERTNY THAT I HAVE PREPARED THAM ATVCAT*N AM THAT THE UNT R WILL SE DONE S ACCORDANCE WRH BAN MAW W COUNTY A <br /> A NE�CEM ND BATE UVA.AM RULES <br /> AND NOVUTMNS OFTHF BAN MAdMICOUNfV.NOM[OWFIEPOPI)Cf NPEDAOEXT'P BgNATVR CFRE)FNB TNEFOLLOWWO:l CtME TNA�MT I�ERMLNCE OFTNF'A'GN(fOR WIBLN <br /> TMB PENAT IB IP6VE0.I SIAL IpT fMROV/JEY f411MON M SVCN A MANNER AP 10 BLCOMf/VSIECT TO VpTtMAN'S COMF[HBATpNUWB LFCa1ROTNA�:ILPMRAOTPM��I111ENO OR <br /> 6V0 COMM"M 61ONATUM CfMNEB ENE FOUO G!l CMR THAT M,NE HN MW t OF"E HOER TOR WHICH TMB FENAR IB IBSIEO.1 SIALL FMItOY TAB)1N9 SIdJFCT 7. <br /> SONEO MNNMAHYCOMI4N LAW.i T /JITMVBi CALL WW NAOV MI TYLE: F/ MB S. LOMtITEOMWMIO SDEIO <br /> MOT RAN pMW,O S:AUT BLAL[ <br /> ' I• <br /> I.NAME.OF STREETS OR MST ADS FORREST TO OR BOVNORM THE PROPERTY. A. LMATMN OF MUMMME TRSFOSµ RUIO <br /> BYPTEM ON SED <br /> 2.ONTUME OF THE FFOKATY.WTN dMENBpN{ANO NOREN UMSECIM N, [APAN6pX OF PEWAOf UN.AAA.PYMFMe. <br /> ]. EAM MNEDOUTLNE.M LOCATMNOFALLfXlB AM MT ORTRVCTURP, C LOCATMH OF WfILS MESHMUCOUS OF ONE HUNDRED FNTV FT.ON <br /> INLL.COVERT.AREAS SVCN Y PAT...MVfWAYS.AND WAV... TRT P110PFREY OR ADAdMMI ROPEIETY. <br /> 10r- <br /> IT <br /> F...EPARTMENI U.[ON11 <br /> 1AT, <br /> 7 AFFiKATION ACCEITED.Y DATEAREA: <br /> TMS,TT DR 6UMPIM6RC1pN J <br /> BY / E� {IyE 1 Jf GDAL,E1 / / 1 NXA.L.I�N/BfFfCTMN(M�Y� E-1 0-J-1 <br /> / 1 <br /> AOdiMNALCOMMFHTM: OIL_ er CF•/) INL- 9 Y-VIAIillE%YY� IIV <br /> AC�OEOVFHM ONLY: MOF TACT 'I <br /> 11 <br /> Fv// !�'� �°IIfAPTE. CM��[A� MCFlVEO.Y OAIEII�� M,IfMATNISM 6 Da3y�I <br />