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APPLICATION FOR UDUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUElUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> a 304 EAST WEEDER AVENUE,STOCKTON,CA 95202 <br /> =� (209)468-3420 <br /> NOR-REFUNDABLE PEB1MT EXNREI 1 YEAR FROM DATE ISSUED <br /> 1CBRI"LMH LB Tr`Babl <br /> APPLICATION Iw IERFSY MADE TO THE L JOIIOIDN COWN FOR A PERI TO COIMrMMT AND.pR w1ET TIE WOME(ESCNND. TN1/APRICATXW IS MADE W COMPIIANC(WRH EAR <br /> JOAOUIN COUNTY DEVROFMENT YRLE.CHAPTER>L 111 O.O AND 7 STANDARDS MGM JDA00M COUNTY PI1NC NENM d"W"S.EWSIOMNMAL HEALTH DIN®N <br /> JOS ADUESSIOR A^HR a 6 j�a N I 1-4 2 IN I T-1 R D crry `-./psi D �U)t SIZE/O•A�- <br /> OWNUI'S NAME N �A)L /"'1 V nI<<. ADORES. 1 N, <br /> CONTRACTOR •,q LPS M. 1 1�'T 1-. AoDFEEE { QS 1 c—6 p c J_I�90 3) Pla•NE 3 a 6�3 <br /> SUB coNTI1ACTORA�J}S SQ�1 r L ADOM88 �' �T Ucj 'NONE <br /> TYPE M SVTIG WOVE NEW 1NSTAILANOM RPAM/ADOrf om❑ DUTRucm"❑ <br /> INO BEPfC SYSTEM PERMITTED IF P'JSUC N.WER IS AVAILABLE WITHIN ZOO FEET Of BULDRNI0.1 PSRO TSATIRI 1 I wild MANY <br /> AFFl�SeA P_ <br /> DRSTALLAHOw R4 SSNVE IESIENCt coMMERCML❑ OTHER❑ <br /> 1 <br /> fNNaRR of UNwO IltIC NUIELEI RY Bm1IOfMtS: HUMBEI OF EMPLOYEES: <br /> CHARACTER OF IM TO A DEPTH OF J HIT: WTMJPAP SOE CNNUCTER: WATERTNLE OE1f1�� <br /> SEPTIC TAMIlO1rAtE TRAP 11 T`/FEIN CAPACTTY ND.cOElANTAENTs <br /> PIO TREATMENT RANT❑ DISTANCE TO N9MW7: WELL FOUNDATION FROPFRTY LINE <br /> NET STATION❑ an TYPE E:f RUMP SAND OIL SEPARATOR ENCLOSED SYSTEM <br /> LEACMNO LINE ❑ NO,S LEHMTN OF LNNEB DISTANCE TO NEAREST:WELL FOUNDATION PROPERI V LINE <br /> FILTER SW ❑WIDTH LENGTH DEPTH DISTANCE TO NEATEST:WELL FOIRAMTIDN PROPERTY Il1E <br /> MOUDED ❑WIDTH LENGTH__DBPFN DISTANCE TO NEAREST:WELL FOUNDATION NIDFERTY I11E <br /> BE9AOE PITS ❑DEPTH se--HUMSER AN TO NEATEST:WELL IOM E?MUl0DAT PROPERTY LS <br /> S{Dil"S Q WIDTH LDNOTH DEPTH ORITANCE TO NEWER:WELL FOINIDATION PROPERTY UWE <br /> DHIfosu PONN O vmTH RENOTN DEPTH OWANCF TO NEAREST:VELD_FOUNDATION MONPIIY IDS <br /> 1 HFAFSY C17MFY THAT I NAVE PFVAEO THIS APPLICATION AND IRA,THE WOW WILL SE DONE N ACCORDANCE WITH SAN JOADIAN COUNTY ORDINANCES AND STATE LAWS.AD NINES <br /> AND RBGUATION 9OF THE SAN JOAOUN COUNTY.HOME OWNER OR IICEMND AGENT'S SIONA.RNE COMMS THE FOLLD`MNO:'I CERFY THAT IN THE RIlWMI1MCE OF THE WOK PORVA41CH <br /> THIS FEVIIET t/RIRRO.1 SMALL NOT BAIPLM ANY DOWN N OWN A MAIM"N TO/SPOONS MRCT TO WOKMAH'S COMPENSATION LAWS OF CALSONSIL'coorn rows mma OR <br /> DIECOMRACTINO SI7NA11NE CERTIFIES THE FOLLOWING:'I CtWWV THAT IN THE POIDPIMANCE OF TIRE WOW FOR WMC"TIES Pv'M ISSUED,I SRML EMPLOY PENSMIO SUS.RCT TO <br /> MIOKYAM• �N"T� OFFCALIF A-'THE APFMOANT MUST CALL K HOUtS N ADVANCE PORUA RSPOUESS NSPECTRONS.COMPLETE D RAFAD EEIOW.SIGNED xVLTI. WM'Y\ TrtLE:�CIN �-�G 1 U 6L WT[' 1 J�7 I <br /> PLOT <br /> MAN DRAW To"GALA CALL Rw <br /> I.NAAE ROADS NEAREST Of Sf1EETS OR ROAD NEAREST TO ON BOEND"IMF PROPS TY. 4.LOCATION OF HOUR NWAGE DISPOSAL SYSTEM ORI PI OPOSIO <br /> Z.OUTLINE OF THE MOFEMY,WITH DMSENSIONS AND HOMN DIFIECTTOH. LIEPAIEON OP SEWAGE DISPOSAL SYSTEMS. <br /> O S.OIMERIONED OUTENE AND LOCATION OF ALL EXISTING AND PROPOCID STRUCTURES. E.LOCATION OF VMjA NNTHBM RADIUS OF ONE HUNURD RFTy FT.ON <br /> INCLUOBIS COVERED AREAS SIGN AS PATIOS,DRIVEWAYS.AND WALKS. THE PROPERTY ON A0.10M110 PIDPEMY. / <br /> ..... ..... .. .. .... C^` <br /> d s s +N9�ECTED N�DUT•NOT <br /> oNew. . ... .. . _ ....>....:...v....... <br /> • O <br /> S3M� � IF�.LE L.� , <br /> . ...... .. . . <br /> •. Y..>. <br /> w . .... .. •E .. .... <br /> 1x[ ... .. ................ .... <br /> J : .. ....i....'..........,.... .... . ..... ....... <br /> Nit w <br /> .... ... <br /> ......... ... . .... ......:....... : . . ..... .. ... <br /> ....... ...,..1R 1s <br /> : <br /> LE11M riNaJ,HNr <br /> ;CE- <br /> 1 3 9 1Ix "_ <br /> 1 �......;..... .. ...... _'...__.......... ...._.. ...... .. ............ . . . <br /> FOR oE► TMOET Off ONLY f q <br /> AAPIICATROH ACCEPTED Br DATE '-Y C/ 7 AwA: <br /> TAM,PIT DR SUMP INSffCTIMl SY DATE. FINAL INSPECTION BY DATE_ / ! <br /> AODITpNAL COSEAENTE. <br /> ACCOUNTING ORLY: AM SAGS <br /> PE CO'OE ( Fa/SRO AM PE OUNT ES ITED N RFz DATE OR I P'EMfT NMIEER INVOICE <br /> T I Tf <br /> Pub,HIIMh S N.-Emlro.174 rVW <br />