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r - <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> ■OM•REFURDARIE PFM EXPIRES I YEAR FROM DATE ISSUED <br /> Kamplet$N f/ylRuv11 <br /> APPLICATION 18 HENEW MADE TO THE SAN JOAOUN COUNTY FOR A PETMT TO CONSTHVCT ANDAR INSTALL THE WORK O[►CFMKD.TNR APPLICATION 1/MADE IN COWUANCE MRTH RAN <br /> JOAONN COUP"DEVELOPA*Wr TITILL CHAPTER 1.1 C 0.3 AND THE WFANDDAj_IC:P OF—JDAOLAH COUNTY PUBLIC N[KTH RM1VIC18.PAmPOFMENTAL NMTN OIVI[gN. <br /> JOE ADORFISATR ANIF ,•` Z� �/����'/`'��f t4> Cj <br /> ITY_ f ib .(T6r� KIT SIZE <br /> OWNEIR'S NAME � <br /> �I1 _per' I/TD K /IV� ADORESR LQ 1 CI <br /> (� ='IV r/ ��( 4p/`)�I,IE�IR-. +'R & FFIDNE <br /> COWMACTaR P—J3T./'.•sC�L'!C ADDS" 'pU� /?LJ �h Q�4r'r L.F– L!C► 7 �" NIGH[ � �.�'S/ <br /> ova CONTRACTOR ADDRESS LK:► 7'N/ONE <br /> TM OF SEPTIC WON(: NEW NSTAL ATION❑ IIOAWAOdaOM�S DISTRIECTION 10 <br /> IND SEFTIC SYSTTM POMRTED M PU MM SEWER IS AVAILABLE WITH"700 FEET OF SUILOWN.I PRIL TISTIH 1 I WIN MANY <br /> � ASPSrIPIw I_ <br /> RETALIATION WILL GIRWE: FEPOENCCW COMMERCIAL 13 OTTER(3 <br /> WOMEN OF ARID IISTS:4—NtPAWM OP ItmROOMN: a__00I001061 OF PAPLOYR/: <br /> CHARACTER OF Soft.TO A DEPTH OF 3 FIM: —PLfR11MP$OIL CHARACTER' WATER TAKE DEPTH <br /> $E►I1C TANKARIEA/[TM-P�, ❑TYP[,VFO CAPACrtY NO.COMPAIIT/LNT <br /> RSS <br /> PKO TATMQlT PL.AHT IU DISTANOE TO NEANS.TT: WELL FOUNDATION PROPERTY UNE <br /> L11R STATION❑ SIZE TYPE OF PUMF SAND OK SEPARATOR(ENCLOSED■YSTRMI <br /> i <br /> LEACHING UN[ MO.\IADTH OF LIES � ��T DIRANCE TO REAR[Si:WELLIJIVOATION �P/0/ERfY LIIC�_ <br /> FILTER SED U FROTH LENGTH_ DETTH 019TAMCE TO NEAREST:WELL FOWgATION PftrGITY LINE <br /> MOUNOm ❑WROTH LENGTH_ DEPTH ORSTANCE TD NEAREST;WOJ. RUNOATMA PROPERTY LIE <br /> SEEPAOS FRS ❑DEPTH am NIMSFII DISTANCE TO NEAREST:WDLL FOUNDATION PIgIFRTY um— <br /> SUPS ❑WOTH (ENGIN DEPTH DISTANCE TO NEAREST:WELL _FEKINDATIDN PFIDFfM LIN[ <br /> DISPOSAL POEDS ❑WOTH LENGTH OMH DISFANCE TO NEAREST:WELL FOUNDATION FIOFERTv LINE <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APKXAT10N AND THA.'THE VMW WILE.R DONE N ACCOKDAACE WITH SMI JOAOUN COUFTTV ORDINANCES AND STATE LAWS,AM FIRES <br /> AMDIIOULATIONS Of TIENLN JOAaU1N COUNTY.HOME OV~ORLICENSED AOONT'S 11 N rLW CERTIFIES THE FOLLO'MAOI'1CORIFVTHATN7IEFE►OIIMANCE OF TNMMAKFOAWHICH <br /> THIS PES./R 0 MORED.1 SHALL NOT EPAPLOY ANY PERSON N MICR A MAKER AS TO RCOME WSAECTTO WOMMANTN COMPENSATION LAWS OF CAtIOREA.'CONTRACTOR'S ROAD OR <br /> KRI CO/NRACTING SIONATUNP CERTIFIES THE FOLLOVAM;I CERTIFY THATIN THE PERNURMTANTE OF THE WaFK FOR WHICH THIS PERMT IS ISSUED.1 M1.LLL WFLOY PERSONS 1RS.ECT TO <br /> WOMMAYI COMPENSATION LAWI OF CALIFORNIA." THE APPLICANT MUST CALL r HOUR N ADVANCE FOR ALL MOUS 9 INSFEOTIDMS•COMPEER ORAWNS aSLDW <br /> SONEDI! T(TIE: .TE: <br /> PPT FUN DRAW TO SCALE)WALE_—'Ie <br /> I.NAMES OF STIEMS OR(ROADS NEAREST TO OR eOLNONq TIE F"OPETRY. 4.LOCATION OF HOUSE emAOM OEOOSAL SYSfEV OR PROPOSED <br /> 7.OVTLEE OF THE FROPORTY,VNTH DIMENSIONS AND NORTH DIRECTION. 1"ANMN OOF 1EWADE OISFOSAL 1YST9AS. <br /> S <br /> 3.OIMENOHEO OvfINND ES ALOCATION OF ALL EOSTNI AND PROPOSED SNJR <br /> TCTU4, S.LOCATION OF VVE"WRHN RADRIS OF ONE NNAORED FIFTY FT,ON <br /> INCLUDING COVERED REAS SUCH AS FATOS.OWWWAYS,AND WALKS. THE PPORAITY OR AD.IOMNO PROPERTY. <br /> ... .. ... . .. .... ....... <br /> 1 <br /> E� SRIF"'" ; .... ,.. ....._ • <br /> E <br /> .. .. <br /> :. ..... . <br /> . l <br /> 1 .C.... . <br /> �...PAYPM W' <br /> y .io.. <br /> . 1 � .:.. ... ..: :. . ... JAN 1Y 06— <br /> OU ....• <br /> hn <br /> IN Dry 104 <br /> SM <br /> FOR OpAT.TIWW i USS ONLY <br /> APPLICATION ACCEPTED SY OAT: — A: <br /> TAM,PPT OR SUMP NP•ECTION SY DATE I I FINAL INNKCTMNSY ATti_�Q1� <br /> AIO K*M COMMEWS: <br /> ACCOINTPN ONLY: /IDS FACT <br /> FS COOS fR NFO AMOVIRT RM(TED CB ASH P=DVM EV DATE q/FRPMT IIUSSEI IFINOICE P <br /> 833 <br /> PDD.Health Serv.-Ermm.174(31W <br />