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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201568 <br /> (209) 4583420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICEERPI.N M TRORE.NI <br /> "FUCA"UN HI ERIE Y MADE TO THE SAN JOAWM COUMY FOR A PERMIT TO CONSTRUCT ANONR INSTALL THE VJOW DESCRIBED.THH ARUCAmN I6 MADE IN COMmANCE MTH BAN <br /> JOA WIN COVNFY OEVELORA[M TUM CR"A 9-1110,3 AND THE 6T AROS OF BAN JOAQUIN COUN'Y FUNLK HEALTH 6E E6. NTA=HEALTH DIVISION. <br /> qB ACORNS. CITY LOT'"t- <br /> ANNE <br /> NAME ApORE88 TTT,��PHONE <br /> COHTMCTOR �ADOREBS / LOI�RICHE%% %/fJ 4'V <br /> RI[COMMCTOR AOOIRB9 LICE RpNE__ <br /> MIYR OF MEMIC WOR.: NEW NITAM .❑ REP/JIIIA....❑ SEATINEMS,❑ <br /> NO SHIC SYSTEM PERMITTED F PUBLIC MINOR N AVAMNE WITNW}OO FEET OF SUROINOJ FDIC TENTH)I 1 NOW MANY <br /> - APala.m.• S <br /> N[TALLATpM..NM,E: NMOFMCE IJfCOMMER:IAL❑ OTHER❑ <br /> _IIMId Of ONMO UMTI: MIl1M(B OP SEORODIA.: NUTASS10F 9AFC fNNN (� <br /> CHARACTER OF BOB,TO ADMIN.Of S CET: IDMEHNP SOS CHAMCTN: WATER TABLE... <br /> F[PTIC IMPRUD AS[TRAP ❑TYRAIM CAPACITY HD.COMPARTMFM-/1S . <br /> TO TMATMdT DINT Q ONTANC!TO NEAREST: WELL PoVNOATp P11ORRry(INF i ^ <br /> LFT BTIMOR 1�S nTYPE OF PIMP SANS ON SEPARATOR(ENCLOSED'SPHINFMI <br /> —LliCNNO UN! HOYS BIEIgTH OF <br /> IME. CL/l DISTANCE TO NEAREST:WELL O FWHI LINE <br /> FILTER Mill IENOTH DVTN CSSTANCE TO HEARSE:W4LL FOUNDATION PORRTY UNF l <br /> MOVNOEO ❑W1OFH��AU [['' (ENO//�Y1N1_OEPD1 gSTANCE TO NEARBT:WELL FOUNDATION UHE <br /> IEER�� DEPTH r l/ESTE[ HVMSER_L__DIBFAHCF TO MAPEST:WELL —D—._ J FMRRTY IME <br /> ryMR ❑RICER LENOTH DINI DISTANCE TO NEAREST:WELL_FOUNDATION PROPERTY LME <br /> dSPoCAL POND. ❑WIOTN UEN TN DEPEN DISTANCE TO MAMET:WELL FOUNDATION PROPERTYUNE <br /> HERBY CS.THAT 1 HAVE REPARED THIS ARIpATION ARM"AT THE WOW WRL BE NONE IN ACCORDANCE VNEM BNI MAOUIN COUNTY OFERNANCES AND STATE LAWS.AND RREB <br /> NDROU.AMN9 OF THESAN JOA.COUNTY.HOME OWEER ON LICENMD AGENT'S MIGRATION CENFIES THE MUOVTM:'I CERTINYTHAT IN THE PFIIFOPMANCF OF THE VgIK FORVAIICH <br /> HIS <br /> PERMIT I9ISSUED <br /> .I NNALL NOT EMPLOY ANY RETRUSION IN SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMRN9ATpN(AWB OF CAUEDREMA.' CONTMCTOR'S HIRING OR <br /> _'%U..NTMCTM 6ONATURE CHRIST S THE MIlOWMO:YCERTIFY THAT 01 THE PERFORMANCE OF THE INOW FOR WINCH THE.MUSUT 19196VED,I NULL EMMOY P N.MRJECT TO <br /> WORIMAN'a COMPENSATION UA%OF CMFO A.' THE ARIECANT MUST CALL N HOURS IN ADVANCE FOR ALL R[OWN IHBRCTRONS. COMPETE MARINO NFLOW. <br /> TD � oAT <br /> MO ID C <br /> _� <br /> MOT MAN <br /> AN—IDMW TO SCAIFI SCALE •to <br /> NAME.OF STMUS OR MADE NEAREST TO OR BOUNDING THE PRORFTY. A. LOCATION OF MUM MINAOE DISPOSAL SYSTEM OR ROMSED <br /> 3. OUTLINE OF THE P10RMY,WTTN MMEH610NG AND MESH DIRECTION. EXPANSION OF SEWAGE MSMBM SYSTEMS, <br /> I. OIMEN6pNED OUTLINES AND LOCATION OF ALL EXISTING AND PROMISED STRUCTURES, 6, LOCATION Of VTLLS SAMIN MMUS OF ONE HUNDRED FIFTY FT,ON <br /> INCLUDING COVERED AREAE SUCH A9 PATIOS,DAI E AYS,AHO W S. THE IMPERTY ON ADJOIMHO PROPERTY, <br /> L I' 29 9 i <br /> 1 IHS <br /> I.. <br /> ` T FOR DEPARTMENT USE ONLY [[[[[[�����Y <br /> R'i�//OAT�ITTI'O'NACCEFTEDBY / T OATE:� AREA: <br /> TAN�,rpi,1E lUNl IH T-- �]U,�1"��l^,L�,v DATE 9 ,�,�y.FINN RBRtTbN BY ^1A'i V �lt✓/` p/,T! <br /> ADA NA.COMMENTS: —T <br /> ACCOUNTINO ON LY: AIDS FACE <br /> FE CODE FFEIHFO I MLOUXTREMITTED CHIC ICA.N RECETVED.1 DATE NIFEIP,NTNLMSEIR MVOICEI <br />