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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> - --^ - ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM RATE ISSUED <br /> ICpaPIAR AI Td lk.MI T 1. <br /> ARFUCATION IB HEREBY MADE TO THE RAN MAOUN COUNTY FOR A PROPER TO CONBFRVCT ANOTIA INSTALL THE WORL OEBCHRIM.THIS AFIICATroN 1.MAGE IN COMPLIANCE WRH RAH <br /> MAOUIN COUNTY DEVELOPMENT TRIS.CHARER 81110.3 AND THE RANOAMOB OF B/W JOAOUIN COUNTY FORM HEALTH SERVICES.EN IMNMLNTAL HEALTH l..N. <br /> JOB AOOPF68{OR AR1_ 1 '%!(��- /,/" B I SIZE <br /> ASTRIC.S -0 /�' A' -, bf11 ..HE <br /> CONTRA[.. AGGRESS W/�k/(CY' 1ICI 'Z7 SHONE 2, <br /> eUO CONTRACTOR AOd266 TIC/ PNOME <br /> A� IYS.OF MSTIC WORK: MLW INSTALLATION❑ FORYRI.WPTIO OFIIRVCNOM❑ <br /> INO 6EFOC SYSTEM R...IF M...{VIER IB AVNLM E WITHIN..0 FEET OF BURONIO.1 RIC TdTNI l 1 HOW M/JEY <br /> /IFOEa�M/ <br /> IM6TAlLATION WILL BBN{: RBIOENCE� COMMEVCIAL 0 OTHER 0 <br /> W <br /> HLMBd OF UM011MTS:�..A.0F pEd100MB: OC_ NUABBI OF dIROYFd: <br /> CHARACTER OF SOIL TO A OEPTN OP O FEET: A k',6.{ RRUMP 6d1-CNARACTEM: }+A WATqNIL TCEDTH <br /> BEF,C TANURESUAF TRAP ❑TYPE/MR 46 Z' m AC %�C/NJ NO.I:OMPARTMENT. <br /> FXO TRESTMENT START O .STAN..T.REAR., WELL FOUNUAOUN RpPEI(TYUM <br /> OFT STATION 10 TN61EE TYPE OF 7MP. _ ✓ OIl SEPARATOR RNCL06E0 BVSTEMI !� <br /> ` LGCRXO UME y� NO.AIFNOTN OF UNEP �'� rLTO"/�� dBTALECETO NEARSf:NEIL JOC6lIO....I.H I'a FMPERIY UNE LT <br /> FILTER SFO AL•I WITTN LENGTH DEPTH INSTANCE TO NEAREST:WFLL F OUNDATION_FPOFEREV ONE 1 <br /> MOUNOF➢ 13 w." IFNSTH .FFTN DISTANCE TO NEAREST:MOM FOUNDATION_STRUE VUNE V\ <br /> EEESNOE RTS ❑DEPTH Sm <br /> BLMPB �� <br /> NUMBER OTANC.TO NFAEET: LLREPERTYUNF <br /> 13 NNTl�lENOTNJ�DFP1M REST!WLL.O <br /> S � v <br /> RUNDATRIN�MURIRYLN/E <br /> A� .'6M.Al FOND{ ❑4W0 UNOTN DEPTH DISTANCE TO MEANEST:WELL RUHOATION�FIORNY ONE <br /> 1 HEREBY CERTIFY THAT 1 NAVE PREPARED THIS APPELLATION AND THAT THE MAN WILL SE DONE IN ACCORDANCE WRN SAN JOAWIN COU Ow OFEIIXANCEB ANO STATE LAW..MIO RULE; <br /> ANONEODUT NBOFTNESANAAW COUMY.NOMEOWNERORUCENBEOAOEW'BNONATURCEIRIFIpTHEFOLLOWINO:'ICERNFYTNATINTHERROIMANCEOFTHEM9 MO WISCH <br /> THIS RRMR MISSUM.I WALL HOT FMROY ANY PERSON M SOON A MANNER AS TO BECOME SULUCTTO VARLMAN'S COMPENSATION LON.OF CAUWPNIA' CONMMFSM.MlGOA / <br /> uUS CONTRA... RTIFIEB THE FOLLOWINO:'I ClFOl TXAT IN THE RISOFMAME OF THE NOIR RR WMCH THIS RRAR IS IOSUEO.I WALL EMPLOY RRSONB eULFCT T. <br /> N NRMAN'BCOMPENSATNOINNLAAWBOFC.WTOWNA.- THE ANF CANT MUST CALL NHOURS IM ADVANCE RR ALL RE�OMREO INS-PECTIONS. COMiIfTE CMNTHO PROnWr' <br /> .TONED It ✓% / �� TRl£: GATE: f'✓ %siM� <br /> .I RAI I..TO SCALD SCALE IR <br /> � <br /> I� I.XAMEB OF STREETS OR RAOB NFARBi TOORpOVXdNO THFPRPERTV. A.LOCATION OF HOUSE SEWAGE DISPOSAL OYSTEM OR PROPOSED \ <br /> UNEO TNEPMPRRY.WITXOMEHSONS ANO NORf11 OIRECTWN EAPANOMH OF SEWAGE ES.ROR T'SRTIB <br /> 3. DIMENSIONED IMES AND LOCATION OF ALL EXISTING AND FROMSEO STRUCTURES. 6IOCATgN OF WELL.W1}.IN RAd11A OF ONE HU.FIFTY 1.OH a <br /> $NCLUTURT COVF DAREAS SUCH ASPATIOS.ORYM S AND WAIXB THE PROPERTY Ofl.,IUFFM3 PIOFf F <br /> c M <br /> `' I <br /> zt{M D�PyL�L�, TSN - •�d�' a�'� N <br /> ... _ " . ... (�To LTJ .... <br /> di'�Cn <br /> _... _. _... .. ...RMS <br /> SAN JtlACUIN[ wNih <br /> VIII _.. ......... FRieGC FfEALTH ShHVICFS '_ <br /> ._. .....ENVIgpNM[NTAI- Far <br /> r <br /> Pon OEPMTMENT USE OMI PINI[AT10N ACCEPTED By OATL v_��-� ARq: �2 <br /> TANR.RTORSVMP p .Y MATE / / FINAL INSPECTION W GATE <br /> A➢DRgNAL COMMEM <br /> ACCOUNTNO ONLY: ARM FACS <br /> FECO.E I FEEING AMOUNTAEMUTED IIF[ (LASH RECRVFR.1 DATE M/{EMIT NUMBER INVOICE; <br /> ISSS <br /> Pub.HBeMI Sen.-F ul.174(3/B6) <br />