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APPLICATION FOR UIl0I0 WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC MMTH SERVICE*'. <br /> ENVIFIONMENTAL HEALTH DIVISION <br /> 304 EAST WESTER AVENUE,STOCKTON,CA 95202 <br /> (209)4683420 -" <br /> jD*jvvffDAltg FnAm 1XIIIJES I TFJIII FWAI D SiU �RrJ <br /> IPnNIEh�Trilr➢aHl "..LLLLrl Jffv��`J \` r'/ <br /> AFFl1CAToN O MEpMW MADE TO Ti OAR JOAOUIN COUHYY FON A PEOW TO CONSTMICT ANOMM INET•.,TME WORK DEICPMP.THIS APPLICATION N k�l <br /> JOAOUIM COUIJIY OWPAPMEMf TM,&CHAPTER 9-1110. µ/p T RANDNEr OF EAN�aPwanrf COONn'VUEIIC NEL.TH rVICM AL NEAETN N. <br /> JOS ANDIESMR.1 � 1 LT/ lt/ ����"ell? cV�• qTY ���M .yLOOTT la'zw /Aof1 c-] <br /> Ow m-9 MOM[ r AOOMSO PIOIrt� l( <br /> COMPACTOR MBS UCO PHONE <br /> SRIRfbNTMCTOFI� AlJO7 lYl �O/Vi C. ._J1001�EE,/-' �C. � J _LN:I�HIONEI� <br /> TYPE OF EEFTIC WORK: NEWINETALLATION po%mAmmm E3 DE/TRUOnON O <br /> y URO MPMC SYSTE/I PERMITTED IF PEIUC WIRER IS AV AR.ASIE WITHIN YOO FEET OF DUIIDINO.R FEIO TS1HR1 l I NOW MARY <br /> /�1 <br /> AFFI�IR YF <br /> INFTALLATON L"LL MWJIE610EIICE C3MER <br /> COMCIAL 0 OTHERJW <br /> Numm OF LAMM LMTS: NUM M nr MI(EYWpI OF RATFEI: <br /> i <br /> C E1L OF Rill To A OEDIN OfFEET IMAAP W_I/L�CNANACTER�WATEII TALE l '•f <br /> _ K/ONRA6E TRA► ❑rAVMFa . 2 RfCh CAPACm Ia`�� NO.COWANTYENTE O� <br /> �TIRM PLANT 13 DISTANCE To WARM: WELL lF�r FOUMATWN /Q- -..- FMOPEN"4!t' - <br /> LNT STATION Cl wrf TYPE OF FUM►T!RANO OR SEPARATOR ENCLOSW CYSYEM) I <br /> LEACH"lwE 'Or .A LLNITx OF 11NE'S���0 C.iL.0 <br /> _ INSTANCE TO MEARFRr,MELL IIO <br /> FOLAIOAYIDN FFEMY LNE��^ <br /> FILTER CED 13 WIDTH LENGTH_ UMN OIOTANCE TO MFAR FOT!WEu FMMMATION PIOrERYY LNK <br /> ALOIEIDFE 13 wmTH kow"_ OEFTN DIOTANCE TO NEAREST:VIM FOUIgATON PIOpUrrV LSE <br /> DEEPASA Rri ` DEITH�L�. / S� «.+w"T_MUIMFII a dsTAMCE 70 NELESY:w[Ei O� FOUNDATWN 16 IIIPF4FFY l7AE d <br /> ILIIFs ❑wwrN Loam _DDPrH DISTANCE To NFNErr:Yom Fau mAT1ON PROPERTY LN E <br /> Di6FOiRL FORM 13 w1DYN LENGTH ,DEFTH DrTANCE TO NEA1ENTI WELk•^,R•^FOUNDATION PROPERTY UNE <br /> 1 NEIEFY CERTWV THAT I HAVE PEPARW TMD APPLICATION AND THAT THE WORK WILL BE DONE W ACCOFdLANICE MAIN VAN JOAQUIN COUNTY OROIIAME0 AND STATE LANA,ATO MULES <br /> MORE OFTNE SAN JDAOLRNC tIDAIEOANNEI ORLICENFEOAOENT'I SONATNRE CERTIRES TNEFOWPNRIJO:•ICEIRIFVTHAT MTLEPEIIPOISUMICE OFTPWMM FORMSSCH <br /> TWO r I 1 SHALL NOY OA0.0Y FERSpN M 21101 A LLANFR AI TO W04M.MCT TO woP m"s CIN4f"OATIDN LAMTS OF CALNOIMA.'CONIRACYOIEN NSVYO OR <br /> W S+JOIVTRACT I1}IE THE ."IC RW THAT W TPE FORIAANCE OF TK WOFK FOA MINICH TTEI M&W A 1114"-I SIAL EMPLOY FEWONE r OL1 TO <br /> NAOIKMAN'S CO C 7M ANT MMCM <br /> LL CL S4 MK"W AWANGE m DIIFWTimm,CO/EIETEIM <br /> IIRIO DELAw, <br /> OgN[U TRTLE� ' f DATF: 1- 6 <br /> PLOT zIPRAW TO IG11EL SC/4LF •m <br /> 1.NAMES OF STPEErs OR IIOADS rIEAILEiT TO OR SOIINomm THE rRommY. 4-LOCATION OF HOUSE WwAOE DISPOSAL.Imm OR PROMISED <br /> E.No:lNO OF THE PROPERTY.%W"DIMENSIONS AND NORTH DIECTMM- tXPANKOR OF 6[LVAOE DAPOSr14 SY07E4S. <br /> IM <br /> O.OENNONEO OUTLINES AND LOCATION OF ALL KXWFM0 AND rROFODED 6TROCTUm% /.LOCATION OF INELLI WRI6N RAMS OF ONE NOMOIED FrtTV FT.ON <br /> 01CLUDOW COARE"W ARESUCH AN PATIO.DRIVEWAYS•AND WAlr[S. THE FRORS"OR ADJONOIO POPERTY. <br /> C� : <br /> oi�iS .. . . /..... . <br /> 1A S' <br /> I;I1:c.c : ���FwLwLJyy .... .... <br /> :.... . .......... . .:�U� .rte <br /> J� rJ <br /> _ .... ... ..... .. ... .. - _ ., 1 <br /> SA <br /> 1' . .. . ........... ..... :.. l...... . .. ... <br /> FDILpvARFMT7/iUSE ONLY � ENVIRONMENTALHEALTH DNIBICJI, <br /> APPLIC/A"7lTIPN ACCEPTED SY I'f^' W' uJ�J6�. RY�: z DAVE: 6 [[�V <br /> CAW.Ilp OR SUMP NAYfC77p1J SY PATE ✓/ NIIL NfSIECIION <br /> AODITONAL COMMEMIS- <br /> 7 <br /> if <br /> ACCOUNTING OILY: AAI FAC. <br /> PV coos ro ONO MOUNT REPAITED CMECEA AIN RrEEY®NY TATE 011 r FENNY 104141141111 A <br /> f I t IS © --- 43 Lb DD <br /> P6h.HIMRM SGM-Emko.174(11M) <br /> i <br />