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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIR COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Zp"" P.O; BOX 380,304 EAST V+IEM AVENUE,STOCKTON,CA li=i,-M <br /> (209)463.3420 <br /> )ION-611URRAILl PINEF EXPINE1 I YEAR F 9 PATE lljUlip <br /> Ipmplalm 1!Tri'vwaW <br /> AFTZICATNON IS nEwEeV MADE TD TN[SAN JOAOIAN COUNTY LR <br /> FOR A PERMITTO QONSIRUCT ANOOR INSTALL THE VMFK OESCWOO.THIO AMACATIOM W MADE M COMPNANCE INTI TAN <br /> JOAQUIN COUNTY DEVELOPMENT TILE.CNAPTER 0.1110.7 AND THE NTANDAROS OF BAN JOAOUW COUNTY PUBLIC HEALTH INIMMES,BNVESDNMENNrAL NEAETN DIVN M. <br /> JOSAODI1ESslOR APNr I L 4C'K, 1 cTrY �+to✓f- SLOT BImE,,, <br /> OWNER'S NAME =I\ <br /> eoNtwcronL1 G f` AoonFer ucr �1' FNONEI^7 77 <br /> am CONTPACTOR AODFFIS <br /> _IICI <br /> Tvm OF scrim EYORN' NOW OWALLAflON my RNPmwADOTION E3 DLATRUCIIOw O <br /> IND s[PTIC SYSTEM P094ITTED IF PUSLIC SEWER IS AVARABLE WITHIN 200 FEET OF I I MNOJ PM TNWMI 1 I HIM PLIANT <br /> AP/EcOsSR s <br /> INSTALLATION VAU SORE: REBTOE a IYCOYMEgCIAI E3 OTHER O <br /> IVAIMI N OF UVWM UNITS: 1 NLMIII OP 2MMOMm: MIMIN CF EMPLOYBN: <br /> CHARACTER OP SWL TO A OEPTIN OF 2 FEET: c N FR/BUMP BOIL CNANNCTEIL• WATER TABLE pVT1L +Y _ <br /> SEIHC TA"OUG(EASE TRAP crrdc MFG LC est CAPACTY h V, NO.COMPARTMENTS <br /> PRO TREATMENT PLANT 13 DISTANCE TO NBARNT: WELL I '��� fiOUNDATgM G•6 prommy LOSE <br /> UfT STATION anTYPE OF PUMP SAW OIL SIEPAIWEO TOA IFNCLOsSYSTEM) <br /> rati <br /> !! r I <br /> ' wISMG LIMN NO.aLENOTH OF LIHES .. � ���,. olirANCE TO NEAIR'STt AEELL �SE�,Qf�FO��UNOATIOM_LaS� PROPE1rtY <br /> "Lynam O WIDTH IENOTM – DEPTH [U <br /> DISTANCE TO NEAMWN w . UNN R <br /> .PODATIOIOP[NTY LO+E CAI <br /> MOUNDED Op <br /> wTH LEHOTM DNPTM DISTANCE TG NEAREST'WEU,—TOISNDATION MOP11–V LINE <br /> S®RNID PITS El DWTN 11cm NUMBEII T DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY LOW F <br /> f SWPS "OTH----a—LEN;; _OEPFN–j-j:—DIBrANOE TO NEARSTt WELL-a �� f*UMATWN_jpXL PROPERTY LWE_ n <br /> 1 DISPOSAL PONDS O WIDTH LENOTNi DEPTH DISTANCE TO NEAREST WELi_ FOUNDATION pRppERry <br /> I HEREBY CEM IVY THAT 1 HAVE FREPARSO THIS APPLICATION AND THAT 111E WOW ANLL N DONE IN ACCORDANCE VJTM SAN JOADIRN COUNTY ORDIMANCER AND STATE LAWN.AND PULPS <br /> AND NOULAr'ONS OF THE BAN JOAWN COUNTY."OME OVAMOR UCENOID AOOIT'B SIOHATURE CEWWRO Tr1E FOULOIA N0:9 CENITIFYTNAT IN THE P9MSnIANCB OF THE WOIB(FM WMCH <br /> Tlss PERMIT IS ISGUE0,1 SMALL NOT EMPLOY ANY PERSON <br /> IN <br /> BUCK A MANNER AS TO BECOME OVBJWTTO WCNXIAWO COMPENSATION LAWS OP CALNFOFWIA.' CCNrNACTOR•O NONNa On <br /> BUBtONTRACTMO AMNATURE CERTIFIES THE FOLLLWINO:•1 CERTIFY THAT IN TNR.PERFORMANCE OF THE WOOL FOR WINCH TMH PERMIT It ISSUED.I OJIAIL EMPLOY FOISONS SUBJECT TO <br /> WOHTMAWO COMPENSATION LAWS OF CALIFORNIA.-INK APPLICANT MUST CALL b HOURS IN ADVANCE FSA ALL RLOUIIIm WSPECTIONO.COMMITS CRAWDIO EE10W. J•L <br /> AtT <br /> SIONEO TITLE: Q�o✓I r�d�T DATE: f Lf I <br /> PLOT PLAN(E)PAW TO SCALE)SCALE •q <br /> 1.NAMES OF STREETS OR ROADS NE BT TO OR BOUFAMM THE PROPERTY. 1, LOCATION OF HOUSE BEWASE DISPOSAL SYSTEM OR PROPOsED <br /> S.OUTLINE OF THE PROPERTY. <br /> wall MME14MONG AND NORTH DIRECTION. UI►ANSMIN OF BEWARE DIOPOBAL sYOT9Ms. <br /> 1.WLLIDI IONEO OUTLINES ANIS LCCMIDN OF ALL MMM AND f7IOpOSm OTNNVCTl11Us, s.LOCATION OFVY[ILS Wrnm1 RADIUS OF ONE NNwNORFD NPTY Fr,ON <br /> 1NCLU01N0 COVJE31[.D AREAS SUCH AS PATIOS,MVEWAW,AND WALULS. THE PMPEITTY OR ADJO"GM PROPERTY. <br /> :T. <br /> _ <br /> i <br /> ..[ : <br /> r <br /> M1 <br /> c .` <br /> ter...;....,..�,�. ..... �, :... . . <br /> IL <br /> :. ... <br /> • M <br /> rl.. <br /> s .{ <br /> .. <br /> lg <br /> h <br /> : .... <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BYr . <br /> DATE; AIS AREA: <br /> U TAIL,IST OR ` A/ <br /> �� ION BY OATE� FINAL INWECTION B DATE S <br /> ADDITIONAL COMMENTS: <br /> ACCOUNTING ONLY; A1OT <br /> FACT <br /> "CODE FR INFO ANIOUNT REMITTED CHF[ ASH REDeVEO SY DAIS OR I P9aBT MISYNOI <br /> WORDS r <br /> Iq <br />