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APPLICATION 'LIQUID WASTE PERMIT <br /> SAN JOAOUIN C(1.Y PUBLIC HEALTH SERVICES .� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,445 N.SAN JOAQUIN ST.,STOCKTON,CA 982010388 <br /> (209) 488-3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> IGmpIYM u Trplluu) <br /> AFFIICATION I6 HEREBY MADE TO THE 6M JOAQUIN COUNTY MR A HERMIT TO CONSTRUCT ANDRAS INSTALL THE WOM DESCRIBED. THIS APNCATION I6 MADE IN COMPLIANCE SATIN 6M <br /> JO AN COUNTY DEVELOPMENT TRIP.CHARTER 8. 110.3 AND THE STMONIDS OF SM JOAOUIN COUNTY MSUC HEALTH SERVICES ENVIRONMENTAL HEALTH W VISION. <br /> .10 ]DIMES./Ofly/A/Q11Y J ` - lez CITY` ((LO[T�& <br /> OWNER'S NNAF Y✓ LNA�121 ADDIIE66 M1OXF 7 / -.3C T <br /> Aow1E66 6' RYt UIc,i R.C.I Cc•S� <br /> SI MTNAC DN ADDRESS I1Cf RHINE <br /> TYRE OF SUMC WDM: MEW INSTALLATION❑ MM,SuC11DN❑ <br /> INQ$F➢TK SYSTEM RWA(fTEO IF PVBUC SEWER IB AVNLABIF WRNIN 300 FEET OF BUILWNG.1 FMD TOTbI l 1 NOW ARMY <br /> ASSISIl <br /> 1.`LL ..WILL SINNE: RENDENC0< COMMERCIAL 13 OTHER OTHER❑ <br /> A=NA OF UYEW UNIT._J7 6M/{j1[Q6FDXO�OMS: (/I N.OF 9AK.Y. �j I <br /> CXAMCTEH OF SOIL TO A DEPTH OF]RET/LP/-(L/dd�/t PIT.fIS�UMP SOIL CHARACTER: WATER TABLE DEPTH �c�Q <br /> M 'TMMIORPAlE TMR ❑TYPE/NSO 1/1<.�.GALW✓ LMACRY NO.COMPARTMENTS <br /> R REATMFNRANT ANT 11 DISTANCE TO NEARPIT; WELL c/T MUNOATON PMPFMV UNE ` <br /> 44,cMNO UmNEmm❑ BMD OIL SEPARATOR MNCLOMO SYSTEM / <br /> -/ /..6FNOTH OF DIETANCETONEARST:W _� UNE - <br /> _ <br /> Nl" EEO WIOTX LENGTH OFPTH GIBTANCE M NEAREST:WELLFOUNDATION_MIONUM LIME 1 <br /> MDIEL ❑WIDTH IDMTHOEITX CAST NCETO NEAREST:WEJIOR <br /> UL FOUNDATN F`ERTY UNE�� <br /> �OS RIF DEPTH SRI 4.1'!'1 j1 NUMBER ,--ETO NFAHEET:V.FUL'16y DATION�m, PROFFIIEY UIE S� <br /> SLMR ❑YYHTFILEMQTH DEPTH_DISTANCE TO NEAREST:WELL_FOUNDATION_PROPERTY UNE <br /> ..'OA,PON. ❑WWTH LENGTH DEnli DISTANCE TO NEAREST:WELL_FOUNDATION RIOPERTY ONE ` <br /> 1 BY CEFG FY THAT 1 XAVE FAEPAPED THIS APP.MATION AND THAT THE WOM WILL BF DONE IN ACCORDANCE WRX BM JOAOVIN COUNTY ORdNMCES AND STATE LAMA AND POPES <br /> �EGULATIGNB OF THE SM JOAOUIN COUNTY.HOMEOWNER OR LICENSED AGENDSSIONATURECERTIHE.THE FOLLOWING'I CERTIFYTHAT IN THE PERFORMANCE OF THE WONT FORWXICX ` <br /> TH16 PUMIT IS ISSUED,1 SHALL HOT MOODY Y DIVISION IN SUCH A MANNER AS TO BECOME SUEIECT TO WMMM <br /> O 'S COMPENSATION LAM OF CMFOR111A" CONTRACTOR'.HIRING OR <br /> =DISTRACTING SIGNATURE CERTIFIES THE FOLLOWING:'I CMIFY THAT IN THE PEPEONAMCE OF THE YIOM MR WXICX THIS PFNMR IB IGGI I SMALL EMPLOY PE1160NE SUEJECT TO <br /> MRSMM'S COMPEN�SSATIT,IO\N\LAWS O/FF CALIFORNIA.- THE A�PPU/CMT MOST CAL N HOURS IM ADVANCE FM ALL REQUIRES IXSRGTION6. COMRETE DRAWINGGFELLOW <br /> TITLE V� DATE:✓ <br /> 0.0T RAN IOM.TO SCAE1 SCALE iF <br /> 1.NAMES OF STREETS OR MAUS NEAREST TO OR BOUNCINGM <br /> THE PPERTY. M. LOCATION OF HOUSE SEWAGE DI6Po6A SYSTEM Ofl FTOMSED <br /> I. <br /> TIME OF THE PIIOHERTY.WRH DIMENSIONS AND WON DIRECTION. EAPMMON OF SEWAGE DISPo6AL SYSTEMS. <br /> J. AENMONM OUTUNES MO LOCATWN OF ALL EXISTING AND MGPOMD 6TIWCNRB. 6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.ON <br /> LUDING COVERED <br /> pAREAASS SUCH AS PATIGS.DIIV AYS.MO WALKS. THE PROPERTY OR ADJOINING PROHERTV. <br /> �ryPCCM}i�'.EEY-l11i\a NT <br /> ED <br /> DEC 81994 <br /> SAN 70AQUIN COIJNTY -- - <br /> PUBLIC FILALTM SFRWCt 17 - <br /> �VIPJhM-_'JTA_Flu'LT� a 1510;2 <br /> FOR DVMTMMIT WE ONLY II <br /> ``CATION ACCEPTED BY GATE: Y AREA? 2— <br /> ......FFECT'ON <br /> -6VMPIN6RCTION BV/ �-DATE .INAL INBFECTM)N By <br /> J1 A+^TIONAL COMMENTS'. / <br /> I` <br /> ACCOUNTING ONLY. NOI FAG <br /> :CODE FEE INFO AMOVXT R0.IRTTFD C EC KASH RECDVED BY DATE Si HDNBTNUMBM INVOICE/ <br /> r <br />