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APPLICATION FOR LIUUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> SESS ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)469.3420 <br /> YBY NON-RFEURBABEE PERMIT EXPIRES t YEAR FROM DATE ISSUED <br /> IlowEla]In Trylint.1 <br /> AALGTMN IB HERBERT MADE TO THE SAM JOAOUM CDVNIV OR A FEWAR TO CONSTAuCT ANDAn INSTALL THE W W(DFACANRD.THIS AKUCATNIN 18 MADE IN COMM1JANCE W SAN <br /> JOAOVIN PDAA I TTTHE, AFTER 9-1110.9 AW THE ETArZ OF BAN JOAdXNL MY FVBUC XEA YN BERVICEe.IBSWM NMEHTAL HEALTH ODDIA.R. <br /> b8 ADORE68 CIrY HOT SDE ��// <br /> �OwNEl1'8 Na ApplF88lk il4e J PMON�7/ <br /> COMI'MCTO AGGRESS ISM �M'• UC, C ' RIO. D <br /> 6W CONTRACTOR ADDRESS UCI PHONE <br /> TTFE OF SEPTIC WORN: .11HITA... APPMNAOpROM OFETRUCTON❑ <br /> OIG SEPTIC INeTEM FFMxrTTO IF NBUC SEWN IB AVARAIILE W HIN 2.FEET OF BURDINO.1 FERC TFATIH I 1 HOW MAMV <br /> AM^FS^e/ <br /> INHAWT F.AAM.. E: RESIDENCE❑ COMMEnCIMX OTHER❑ <br /> _NLMNFAOFIMNOUMTA:�NIAAEAOFBfd10 . � HINTER OF 6IAWDYFFB: <br /> CHARACTER OF SON TO A DEPTH OF]FEET: N Wf MP SOIL[HANKER: WATER TABLE DEPTH <br /> BER1x TANNIOI6ASE TIL1P Z TYPF/M CAFACRY�n`Y 1 M.coMFAmAPExrs l <br /> W(p TIFATMENT REAM 0 ..TA.CE TO BEAR : ODUMATIOM I NDNNNDY UNE <br /> LFT STATION❑ WELi�/{EpppI(/TT�NN TYPE OF NMP SAID ON REPAMTOR IENCUDGUI WIDEN? <br /> .1 1j <br /> gLiALi to Bd 2 � MWOTH`IF.ODEPT <br /> TH H DISTANCE TO NEAREST:WELL FOUNDATIONt AEOMON..E 10' <br /> MpyMpFD ❑WRITII tENTrD EASON�DISTANCE TO NEARER:WELL FONNDATON PROFEXTr UNE <br /> ROSA.PTS 01E114BRE MMBER�bis,r E TO NEAREST:WELL MHNDATNAI ANNNN YUNE <br /> SUMPS ❑WIDTH LENGTH DEPTX_DISTANCE TO NEAREST:WELL_FOUROATION�PMFFRry UNE <br /> MFb6AL FONDS ❑WIDTH IENI IF _DRTANCE TO MEANEST:�MUNDATIDN__PADMFTT URI <br /> I HEREBY CERTIFY THAT I HAVE FFNPARO TMB AF0.RATHIN AND THAT THE WONT WILL RE DOME IN ACCORDANCE WRH BAN AAGWN COVMY OIOINAMCES AND STATE LAWS.AND RIAE9 <br /> AND RED"ES IS OF THE BAN A5AWM COUNTY.NOME OWIIEn OR,".AGENT'S BpNATUM CERTIFIES THEOLLOWINO:'I CERTIFY TM.TIN THE FEttO1MANCE OFTNAM W OR WTEICM <br /> MS FERNST IS ISEWM.I MALL NOT SMTOV AM'PERSON Al MICR A MANNER AB To BECOME BWJECT TO WTIrKMAN'B COMFENOAlIO.LAWS DF LALMARA.- COMRM:TOR a WANG OR <br /> .URCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING:l CERDFY THAT M THE FEPFORMAMCE OF THE WOM MR WINCH THE DEFEAT IB ISSIIEO.I MNL EMKOY PERSON9 SVBIECT TO <br /> �YAMMAN0 CO0 C�_OOM�F(ETN/ST'ATROIN WBNOF�IPICAI-IPOWNA' THE APWJCANT MOST CALL SA HOURS M AWAMCE RM ALL MROSS�R/E'D]IN6E/1�OPEMERMS. COM0. WNRG <br /> £TE ON: BELOW. <br /> Tm �AVLL2 Lll� OATE9 <br /> 0.0T MN(DRAW TO S ALO MM-E— <br /> BAS'1.NAMES OF STREETS OR MADE WARIEST TO OR MUNdNO THE FFIDM Y. A. WCATWN OF NOIN E SEWAGE P FARM.SYSTEM OR PROMSED <br /> i.OVTUNE OF TXB FRO ITTY.WRH[A ENSgMS AND..IN FDOA.MON OF etWAOE DIBOBAL BV3. STEMB. <br /> DIMENSIONED OUVIMEB AND LOCATION OF ALL ESIS1.AND PROPOSED BTRVCTVRO. 6.LOCATION OF WEUR WTHIN MpVe OF ONE HUNDRED FIFTY FT.ON <br /> HCWpMO COVETED MEAS NCH AS PATRIS ONVE ',AND WAll:6. THE PMFERTV OR ADJDIMNO PORflTY. <br /> flnnP,vMos Pu,a ' - <br /> YJE 7.Our=lµGTE <br /> PMP,,MA- <br /> y _ i <br /> Ili N i I <br /> I I <br /> Et <br /> 7- ,77 <br /> -- y r 1 <br /> x \ pro <br /> I% LU <br /> 19JO D _ - <br /> : <br /> t <br /> t. r• npvnvTMFNr we oxLr ` R� <br /> APFUCATION ACCEPTED BY • h DATE: AREA: \/Iv <br /> TAM.M OR NMP INSPECTION BY /1-/��GATE / FINAL IN9PECTIDN BV ATE DAll <br /> ✓-a <br /> ABCpVNTNp pfAT: AT, / FAL, <br /> FE coOF PV IIAO AMODNI RDmITFO EIFc AM Fcwmf. GATE FRRFmAW NIMSFI cE, <br /> 21 S `LS� c:a= 176 . �� ", •?� Sk � <br /> Pub.Heam SAN.-EnAlro.174(3 96) <br />