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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ' P.O.BOX-8K 304 EAST WEBERAVENUE,STOOMR CA 95MI-M <br /> • (209)481.3420 <br /> 110R-REFUNPARIE PERMIT fXPIRES I YEAR FROM DAT€ISOUED <br /> Ir'GRRIPwb In Tr4DPGMI <br /> APl1CATIM r NEIERY MADE TO THE MAN JOAD IN 00iftrY FOR A PERMIT TO CONNTRUCT Mo.OR INSTALL THE MIOW DESC MSS, THIS APPLICATION If MAGE N COP:SUAHCf TVRH GAN <br /> JDAOuN DOUATY DEKLOPM®J7 TTRL3,c"AFRFII s-1110.3�ANDTHf fTAmaAXJS OF SAN JOA[1U IN coum"PUfIK HEALTH/OhWAG.F1 Vrl3K*1BITAL HEALTH OMMIOM. <br /> JOS ADOREfUM APNf 5 �GJ V lam. t.A- kl]2t'�4 y`� CITY �o LOT flrL •C� <br /> O040NE"HAAS La���C � L_—�• AOOREMM S*rWNC ,( <br /> CONTIIACT(M�'L. �1.0'TLL- ADDRESS 1� � '.�+tP•+'. '1-•r1 LICE ►NOIfL��.4 393 <br /> GIM COFJITNcmm ADDRESS UCP PIDIA <br /> TYPE M mErm WOMI: NEW NSTALLAMN E3 fEPARVADDI1101I b.ST1MICAON❑ <br /> W sorm SYSTEM PwmwTm F PRLIC SEWER If AVALAAE YArMN 100 FEET OF WJ UHHO.1 RIS TSSTh1(1 HOW MAST <br /> AFM-Mw f <br /> INSTALLATION WILL SEMS; nIPIDE.E COMMERCIAL 11OTHER❑ <br /> AIYER OF UNNO UNITS:_MIA,—OF fGDIIOOAY. 3 NLMMER OF MASROYNs: <br /> CHARACTER OF SOL TO A DEM OF JI FEET:, [--FbY-k, PrTmuMP BOK CHNYCTFR: G�/ WATER TAME DEPEH� <br /> fFPM TANN/OISASS TRAP . ❑TMEM'FO CAPAC FV NO-COMPARTMENT, <br /> NCO TMATMER,PLANT❑ OUITANCE TO NfAKUT: WLILL____f____` FOUNDATION PROPERTY UNE \J <br /> UFT STATION❑ On TYPE OF PUMP SAND Ol SEPARATOR OKWOED SYWEW v <br /> LEACNNN WF ® No,w LENOTN OF LINES_ DISTANCE TO NEAMIT:WELL O 1 FOUPODATIOL.LD_PIOPORYLINE <br /> RLTM Mm ❑VMOTH LINOTH_ DEPTH OSTAHCE TO NEAREST:VVFLL FOUNDATFON MkAV Y1)fE <br /> MOUEIOm O WIDTH LENOTN_ DEPTH DISTAJICE TO NEAREST:WELL FOUNDATION PROPERTY U NF <br /> G®AeE RTr1 0 DcrrNlalrE y�T IVUAPSDI a DISTANCE TO IEIJEfT:vI nLQ_FOUHOAT �PPOIIIRY LAE <br /> f1A1lL ❑MOTH LENGTH DEPTH DISTANCE TO NEAREST:WELLPOfJNOATMN PROPERTY UNF <br /> OMPOILAL FONDS Q MLDTH LENGTH _OEPrN DISTANCE TO REAPER:WELL rOUMATION ROPFTY UNE <br /> I HECSY CERTIFY THAT 1 HAVE PREPARED TNS APPLICATION AM TN.LT THE WOFK WILL ME DONE IN ACCORDANCE WITH SAW l.OAOIRN COUNTY OIONANC[f AND flA71 LAMA.AND OAKS <br /> /HMD RESULATI"OFTHE SAN JOAOUIR COUNTY.HOMF OWNEFORUC!WWO AOEIT'M PMATDIE ceKrWM TRE MLIOVANO.ICUM"T14AT INT/l P97ONAANCE OF THE WOFK FOR."', V <br /> TMS PPMT 14 ISSUED,1(HALL HOT EAPOY ANY POSON N SUCH A MIWIIER AM TO SWOME SUSJOCT TO WOIKLJAAMS CCAOFUIfATMNLAVI P Of CAIIPOIMIL' CONTRACTOIrS Mrom ON !L�� <br /> SLRCOMTRACTW40 0"ATUAt CERTIFIES TEC FOLLOWINO:•1 CEKnFY TfG\T IN THE ra"mMANCE OF THE WORM POR WMGN TMG F'EPMT IS ISOM,I&HAL EMPLOY PERSONS SU/JECT TO <br /> WORRMAN'G Cou"NM H LAWII OPMI RIIA.' HE CTAPPUCANT ARMY CALL 24 NOW NW <br /> AANCS FOR ALL PKW WAD NSMCTIOMS. COWFTE LDRAMM BELOW- <br /> "OWED X ��� r%.L TITLE: S71,J✓Yr IL L fL S C.OATE, <br /> ROT PJIN DMW TO SCALLT SCAtE _'d v�fTY <br /> 1.NAMES DF STREET.OR ROADS NEAREST TO OR SOVNOSIO THE PROPERTY. 4. LOCATION OF HOUSE GEWAOE DMPOSAL WYWMA OR P OP'OS® 4`T <br /> 3.OIIR1IlE OF THE PEDPENTY.WITH DNAENIND/p AND NORTH DIRECTION- DIPANIIUN OF GEWA0E M <br /> OIS OL SYSTEMS. YY• <br /> 3.OM1fNSONED OUTUHES AND LOCATION OF ALL EIEHRINO AND PROPOSED STRUCTURE., S.LOCATION OF Will"WIRE/RAMP OF ONE MAM"M FIFTY R,ON <br /> NCWDIMM COVETED MEAS SUCH AS PATIOS.O IVIEWAYS,AND WNL(.. THE PROPERTY OR ADJORSNI FROP9ITY. <br /> . . . ... ..... ........... <br /> .......... <br /> ....... .. :. _ ..... <br /> ......r.... . .. ........ <br /> • <br /> t. <br /> "Y <br /> ; <br /> ; <br /> , <br /> ....:...........i.....�.. . ...,....... ... <br /> t <br /> ..u.... :.....�.. .. .. ............f.. '... ... <br /> I <br /> t <br /> ... '.....i......:. .i. .:....:. <br /> : <br /> ............ <br /> ...e......:......h...........s...... 5 . <br /> . .... .:.....:........... ..'.. <br /> .... .P�1Y�iAEN7.- <br /> ........... <br /> ...s..... .. _.. <br /> .:.... ... .... . ped t.219-97 .. ..... <br /> ...:... y. <br /> ..,...o. :. ,....n.,, GHEJ4ILTW.S � <br /> . . .....:.....�.....;... > .... woa,a a.,z. <br /> a. ., <br /> 6 <br /> FOR O@ARTMEIT IME DIEM <br /> APPLICATION ACCEPTED 1Y OATS <br /> TRW[, SUTAP INSPECM.N tN bAT{O/.Z Ra4AL NG/lCE10N fV Lrts/MOATE�U /�'^/ <br /> IV <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING OMaY! AIDJ FACJ <br /> PE COOS FR INFO AMOUNT FAMITHI HE ASN RREVMD ST DATR Al I P9NET Nlfinel NLVOHCS f <br /> o ! 0' 0419sg <br /> Pub.Heath Serv.-Emlro.174(3188) <br />