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<br /> 14 APPLICATION f0R.LiGU1 V;ASTE,PE RMIT�
<br /> SAN JOAQUIN COUNTY'PUBLIC HEALTH SERVICES
<br /> ENVIRONMENTAL HEALTH DIVISION
<br /> F304 EAST WEBER AVENUE, STOCKTON, CA 0520�pjo �p
<br /> (209)+468-3420 Orr Gc��,,%v
<br /> k APPLICATION It NENCeY#AAOt TO 711E CAN JOAOUIN COUNFV FOR A PIRMIt TO CONSTRUCT ANDAM INlt7Al1 711[WOIK DttlCR16ED. T1 MF,Ai7Y/CA7KIN It M�AD #�MPLfANCE 1M'FN CAN
<br /> JOAOUM COMITY 6IVE/OPME1 TrTLt.CIIAPTrR B-1110.3 AND THE STANDARD!OF CAN JOAOjn"COUNTY PU@LIC HDALtII SERVICE$.fNV1ROHM[F iRrSS.11��
<br /> Jae ADIN1[@eAOn AiYI1 F T T N -d t7-3 use-P4-,rrr'J i 99-8 c1TY LD d I0119L]c{V►�i x$c�►�� 91�N nu
<br /> OWtIIR'@NAME Ber#Torrc5.c-qger0pme win V V=AMMAN.I DO ftiSf_Hdena, CA
<br /> c,,.RAC7,.cQyiD_OK EaRfih }7'e< nulmcSADDREes y� we 4rc1 Sk? fl�. -E I+,a11E ^ -b5I
<br /> fU@ CONERACTOR �7 Dr 1 1 1 -Y D r I 11 n0 _ ADDRECC 11 JLJ AMU 1 A Yl
<br /> tm OF SFMC WORK:
<br /> N1W INSIALLA7}ON REFNIIrADplIO4@ ❑ bt@1RUCTIDN ❑
<br /> @IO S(rTIC fYfTETA repmr"ta jr rUBLIC SEWER I@ AVAILAOLE%Mf lllN x00 FEET OF BUI13IN0-J PMiO Tt@ll.t l 1 IpW MANY
<br /> F� AIII$••tM S
<br /> -1. INSTALLATION W111SAVE: RE9IDETICI ❑ COMMERCIAL OTtim❑ L
<br /> NWGIR OF LIVING91 1rMTSr_N� NUMCOP IMMOOMS: NU" OP
<br /> MImps, E'ilr_.. f��er 7 v�p p
<br /> _7
<br /> I CIIACTIR OF SOIL TO A DEPTII OF 2 FFFT: —S PTTNIUMP COIL.CIIAMCTER: __ WATER TABLE DEPTF
<br /> SUMO iANK1'ORG66 TRAP ❑7YPt/MF0 CAPACITY NO.COMPARTMENTS _
<br /> -+ FKO TRIATSAtNT PLANT❑ DISTANCE TO NtARIITr WELL FOUNDATIONPnOPF1TTYLINE
<br />• UFT STATION 0 SIZE TYPE OF PUMP @AND OIL SEPARATOR ItTICLOSED IYCf tIA1
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<br /> LGCI@NO URN ❑ M.•1IT16T11 OF UNE@ DISTANCE TO NEAryE9TI 1hrELL rOUNtfAT10N I"11/'ERI'Y LINE
<br /> nLTM SID ❑WIDTH LLI1GT11 DEPTH D 19TANCI TO MAIIE@T1 WILL rOVMATWN PnOPfKTYUNF
<br /> 1 MOUNDED ❑WIDTII L,ENOTII DEFTO D19TANCE TO REAM*TO WELL FOUNDATION PnOPERTY LINE
<br /> 1 :UFA09 Fits ❑DEPTH SIZE NUMBER DISTANCE TO NEAREttt WILL POUMATION PFOr4RTY UNt
<br /> ti SUMPS ❑V'IOTII Ltr1OTl1 DtPTII DISTANCE TO NEAMOTt WELL FOUNDATION r"Orl"rY LINT . -
<br /> ! DISPOSAL FONDS ❑vmlif IENOTIi DEPIII DISTANCE 1O NEA OTt WELL POWMATION PMPtnTY LINE -
<br /> I I frtnlBY CInTIrY THAT I IOAVE PnIPAntr)1111$Arr UCAIION AND TIIAt 114E WOrK WILL @t DONE IN ACCORDANCE VNttl SAW JOAOUIN COUNTY OMWANCt@ AND STATr LAW@.ANO FMIS
<br /> Alto REGUlAT ION@ OF Till @MI JOAOUIN COUNTY.NOME O"It ROR LICtN@EO AOtNT'S SIONAT URE ClI nT IFIES 711E FOLLOWINOI'I CtNT IFY711 AT INT IOR PtMORMANCE OF 1111WORK FORVN$CII
<br /> TFn@ PERMfT Is ISSUED,I$IEAIL NOT IMMOV ATIV PEnSON IN$DCII A MANNER As TO BECOME SUBJECT TO WORKMAWS COMPtNfATION LAWS OF CALIFORNIA.' CONTRACTOR'S HW#M OR
<br /> @V@�OOrT MCTITIO @IONATtInI CErtIFIC@ T11E FOLLOWIFIOI'1 CERTIFY THAT DI TIIE rTrW0RMANCF OF TIIE WOIK FOR WIIICII THIS RRMrT 1@ 1@SU[D.1 SMALL EMPLOY Rn90Nf fURItCT TO
<br /> WOIKMAN'S COrAMNIA7000I LAWS OF CAL1rOMIIA.' Tilt APFUCANT MUST CALL 24 IMUR@ IN ADVANCE POR ALL RfGUMED IN•KOTIONS, COMPIITt IIMVNNO BELOW.
<br /> 6
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<br /> orrEo X TIT Lli �ru_I p e --
<br /> M 0 M G f/R r DATED &&61-9 S'--
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<br /> ! PLOT PLAN(DRAW TO OCALE)BCAIEr•,���'I• aoo
<br /> 1. HAME@ OF S1PEtTC OR MADI NEAREST TO OR BOUNDING 111E 1`110T21TTY. 4. LOCATION OF IIOUfI CEWAOE DISro@AL fY@TEM OR PMrO1tO
<br /> 2. OUTLINE OF 7111 PMPEMV.WRIT DIMER@IONS MIO NORTH DIRECTION, EXPANSION OF$IWAOt dSMCAL SYSt'II.tS.
<br /> 2. DtNONEO OUTLINES AND LOCATION OF ALL 1XISTIM0 AND rMPOSED BTIMCTUnES. B. LOCATION OF WILL@ VYFTIO"RADRrf OP ONE HUNDRED IIFTY IT.ON
<br /> IMII
<br /> BICLUDING COVERED AnEAS SUCII AC rAT1O@.DRIVEWAY@,AND WAIIL@. Volt PIOIYRTY OR ADJOINING Pr1OPIRTY.
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