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APPLICATION FOR LIQUID 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 /> 101•REFURDABLE PERMIT EM"l 1 YEAR FROM DATE ISSUED <br /> (C/MILML/ti TrOVastal <br /> APPLICATION W HEIEEY MADE TO THE SAN JOACUIN COUNTY FOR A PEMAUT TO CONSTRICT AND,DR INSTALL THE WORK DEWPIRED.THIS AFPUCATGN R MADE N COMPVANV-WITH SAN <br /> JOAOUN Cotm y OEKLOPP%KwNT TIRH CNArM F- I'//0.11101) ID..3 ATHr STANDARDS OF SAN JDAONN COUMY FUMX NmTH auwxES.ENVIIIDN AwAE HEALTH <br /> JODRAM <br /> S ADDII186"A�"NJ 1 aQ`O 'C c 1 Tn SYS R Q c CRY .7TH-K-I.O n w <br /> OlWRR7NAME ^1A- -G I�-r A-d a/1'L•L+ ADDREM J�lk�i PHONE <br /> CONTRACTOR (/1 E,'�Ct_. tqt if*lr ADDRESS ?I r)K &S Q UCF&61�5-5-lq PHOr4 4.7 <br /> S'IJD CONTRACTOR ADOFIE89 IfCI "HONE <br /> TYPE OF SuFm WORK: NEW MSTALLAf/ON PWASVAOMn0M❑ GOTRLICTION❑ <br /> NO SEPRC SYSTEM PERMITTED IF FVNX BEWER 18 AVAAA&E WITHIN 200 FEET OF SIRIDMa,I P9C TE1TN1 I I WJw INAMT <br /> M., AFNSISSNH F� <br /> INITALLITION WILL WIVE RESOEHCE tk"'COMMEACIAL❑ OTHER❑ <br /> MMUNA OF UVINO UIMTS: NLAWlMI OP EIDI)IDOAAM: -3 NII.+eI OF wnEDYF2s'. <br /> CHARACTER OF SOL TO A DEPTH OF 3 FW:.. PRTALGO'SOIL CHAAACTEK L WATER TASTE OEPT1t�� <br /> al"C TAIMUOREAEE TRAP YO TT� �'F L- cAPACfrv, l p.'�]{] No.Comp"MAENT2•d- <br /> WO TKATIMEYT PLAINT❑ orSiARCE TO NEAl14lr: Wfu sa' FOUNDATION .�o, FROPEAry LNrt�o' <br /> LIFT STATION❑ SIZE TYPE OE PUMP SAND OIL SEPARATOR ENCLOSED SYSTEh11 <br /> LEACHING INE P-NO.B LENGTH OF LINES_. 4W' DWYANCE TO NEAREST:WELL _FOUNDA;;;__ffflQ^FROPERTV EAE f <br /> RLTM SED ❑VAOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL P"JDATLON POKWE IV LINE <br /> L"MM ED F❑-LWIDTH LENOTH_ DEPTH DISTANCE TO NEAREST:VWELL POIAMATIONPROPERTY UNE 1 <br /> N®AOR RTS La DEPfiI�Na 3(� li NUMBER_DISTANCE TO IEMEM WI L ran MuNDATION_ 17 a PPO EMY LINE 10 <br /> MI4n ❑WWM LENGTH­OWTH DISTANCE TO NEAREST:WELL PDl1MAWTTON PROPERTY LIQ <br /> MSbSAL FOILS ❑WIDTH Loam_amm CHITANCE TO NEAREST)WELLFOLNDATON PROPERTY LME <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND TRAY THE WORK WILL SE DOME N ACCORDANCE WITH SAN JOAOUN COUNTY O""I"A KES AND STATE LAWS,AND RRES <br /> AND FIEGULATIONS OF THE SAN JOAOU W COUNTY.HOW OWILRORLICMISM AGENT•/MONATM CERTWW8 THE FOLLOW NS''IMMY THATN THE PEMOILLANCE Of THE WON(PORLVAMH <br /> THIS PERSYT IS MUM 1 MULL NOT EMROY ANY PERSON M SUCH A MAINE)AS TO WCOW MJLJECT TO WOIKM OLIN'S CO WIIMATION LAWS Of CAIIONBA•. COMTRACTO"HMG OR <br /> KJLCONTAACRHO 4KNATUPW CERTIHES THE FOLLOWIM:I CEITMY THAT N TIE PE FOR FAAFKE OF THE WORK FOA WHICH THIS PERMIT M ISNED,1 SMALL EAPEOY PERSONS SUBJECT TO <br /> WO KHANS OOMPENMTION LANAIS OF CAL"F"A.' THE APPLICANT A1UMT HALL 24 MUM N ADVANCE FOR ALL MOLRIED INSFEOTIONS. COMPUTE ORAWSNO SLOW. <br /> HONED K ,! TLE: Ca R frCC-�r DATE: <br /> LLK4YYY� PLOT PLAN <br /> !DR^W TO SCALE)WALE !o <br /> 1.NARES OF STARTS OR ROAD/ IN <br /> IEESY TO OI 60LINU M THE PROPERTY. N.LOCAMN OF HOUSE SEWAGE OIIPOSA BYSr01 OR I POPOIND <br /> 2.OVTIIFNE OF M RROPWrY.WITH DSABNMONN AND NORTH DIRECTION. EKPANMO/!OF SEWAGE DISPOSAL WyWr MS. <br /> �.DSAENSOIEO OUTLIES AND LOCATION OF ALL EXISHM2 AND PROPOGFD SRSUCTUREB, E.LOCATION OF WELLS VRTMN RAGAS OF ONE HUMORED FIFTY FT-ON <br /> NUVD04 COVOEO ARRAS SUCH M PATIOS,DFWAWAYS.AND WALKS. THE PRORRTY OR ADJONNS PROPERTY. <br /> . c <br /> i <br /> r <br /> ............... <br /> Q -� <br /> '.... ..E <br /> -SEP 2319M.. <br /> . :....-. <br /> ..[... ..+...... ... .... .... i.............. ... ��... '. . ...:... ... 'RJIW.MALTA SC;Vf^fES....... .�"ROWSWA-HEALH ... <br /> .. <br /> W SION . <br /> ...:..... : .1%N...... .i ... .. .... .. �i <br /> cs <br /> a <br /> J <br /> -- <br /> FOR DOARIMdT W1 ONLY j <br /> APPLICATION ACCEPTED Sy SATE C• `" A0.EA:OL/f •",^ <br /> TAMIL.<R OR MAP MIMECTIOI!BY ' DATE I FINAL[)MIECT10N SY TE_ <br /> ADDITIONAL COMMERS. <br /> LL <br /> AccoUNRVa ONLY: NOF FACE l)J) <br /> PE to" ERE INFO UAOUIIT R"ITT )CASH REOEVED SY DATE M l!MMMT)ILIA m HNOSCE S <br /> As3q 4 --- � <br /> S z0 b 30 <br /> Pub.Hsehh Sem•ElMro.174(3" <br />