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APPLICATION 'R LIQUID WASTE PERMIT <br /> SAN'JOAOUIN L—EY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION SSSS <br /> -�, - P.O.BOX 388, 446 N.SAN JOAOUIN ST., STOCKTON,CA 96201-038B <br /> (209) 4683420 <br /> NON REFUNDABLE PERMIT EXPIRES I YEAR FROM BATE ISSUED <br /> (Complete ill Trblisotel <br /> URKM1TgN It HENEBY MAIN TO THE WIN JOAOUIN COUNTY FOR A RPMIT TO CONSTRUCT ANAOR INSTALL THE YAR(DESCRIBED.THIS MPNCXTION IS MADE IN COMPLIANCE WITH SAN <br /> JOAOUIN COUNTY OFYFIDFMEWT TITRES CHARER 9-11101.3 AND THE STANDARDS OF SAN JOAWIN COUNTY FUS U,HEALTH SJFNY�ICEIR ENINPoNMEMAL NEALTH mW&OH. <br /> Ae ADmes6mn(A'1PMA� /'���f(���` aml. T/tL E.�Ea 9�//�/1 • clrY�'L'�U�1�e�r� LOT gn <br /> OWNER'8 AMIE SB 'H-^ I 91 <br /> FTPoNE <br /> CONTRACTOR I Op�{sJ-MC I�E ADOIF88 nI/J C /� �p (ICJ PHONE <br /> SUBCONTRACTOR —gzl� r - _ADM<M J�E A O ` L r05�-� ` r -11CI RHONE <br /> TYPE OF AUSTC WORK: RWwAD N 13 oMTRDCTax❑ <br /> IND SEPTIC SYSTEM PERMITTED H MSM NEWER 1.AYARLAS E WITHIN 200 MET OF SUIIDING.1 FEW:TOTMI I 1 HOW MNIY C 1 1 <br /> �q .MRNMHR. <br /> LL SINE: Liv 1 <br /> INSTALLATION WIENEMDEN11CE COMMERCIAL p� OTHER❑ <br /> ....OF UWMO VMT.: MISER OF MONSOONS N..OF 9APlOYFE6: S O <br /> CHARACTER OF SOIL TO A MPTH OF 2 FEET: WRIUM1P_SOL.CHARACTER:CIA,4 TER TAME OEPTN <br /> smlc rAIKmREAEE <br /> TRA, QT�PErMFO /�r`[f Cl+f' cARAcm /C �th xD.coMPAmwwrN <br /> MO TRWTMONT RANT O INSTANCE TO xEAREAT: `NFIEFOUNDATION FTgRMY UNE I� <br /> UFT STATION E:r�S FF TYRE OF R/MP BAND ON SEPARATOR IENCIOSED SYSTEM( c -57 7 / V <br /> LFACMNO USE 1J NO.A IENOTH OF UNE. q X I p D St DISTANCE TO NEAREST:WELL //!51,2�J0/ RFJOMRTY ISLE j(� <br /> HLTER SED OM'mTH LEHOTN DEPTN DIBTANCETONEAl n:W6L MUNDATIIN4Q (/ RWREFY11NE �w <br /> MOUNDED 13 WIDTH LENGTH MPT. INSTANCE TO NEAFER:W£LL ,J^ FOUNDATION WOREFTY UNE <br /> FEEPAOE SITN �SEPTN 86F NVMSFR�INSTANCE TO NEAREST:WFIL�[y(_FOUNDAT.N RRTY UNE <br /> FWM ❑YROTN LENGTN DEPTH NOT ANCE TO NEAFEST:WELD FOUNDATION RCI UNE y <br /> UUUO.AL MMS 0 uEN DEPTH_MBTAWETOHEAREST:WEU_MUNDATMH PIIOPERTYUNE <br /> I HERESY CERTIFY THAT I HAVE RZPMYD THIS ATSNN AND THAT THE WORK YOU BE DONE IN ACCIUMANCE W'RH BAN JOAW IN COUNTY ORDINANCES AND STATE NWB.AND RBE. \ ` <br /> ANOREODUTONB OFTHEMNAAWINCOUHTY.HOMEOYMENOn UCFNBEDAOEW'SMGNATUMCERTIFHBTNEFOLLOW'TNG:'ICERTIFYTHATIHTHEFEMOW.EOFTNE.A MRVMM. <br /> THIS RRMR IS IBa' I SHALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME SUBJECT TO MIS MAN'S COMPENSATION LAWS OF CAUFOPNM.- CONTACTOR.HIRING OR <br /> 6Ue ONTFACTINO SIGNATURE CERTIFIES THE FOLLOWINO:'I CERTIFY THAT IN THE RERFONAANCE OF THE WOW FOR WHMH THIS MRMR 18 ISSUED,I SHALL EMPLOY FERSONS SUBJECT TO <br /> .WMAA'8\//CI❑11MPENSATIONI.AM OF CAUMFMA.' TM MLCAxT MUST CALL N Ho.IM ADVANCE.ALL RNS <br /> EDIMFO H1PKT-INt- �COMPETE DRAW'1HO.SEELOW. Y� <br /> 61GNED x LL/ ,1 U AfA w.( TIRE:/'� 51 VR{ IRM/@2 /vl/ll h DATE: /l� <br /> ROT RAN I..TO SCALEI.CME <br /> IN <br /> NAMES OF STREETS ORROADS NEAREST TO OR ROUNDING THE FMIPENTY. A.LOCATION OF MUSE SEWAGE M6108AL SYSTEM OR FMMNEO <br /> 2.OUTVHE OF THE PIq PERTY.WITH DIMENSIONS AND NORTH MMW <br /> CT H. EXPANSION OF SEWAGE M.MSAL SYSTEMS. <br /> 1. OIMENBNINED OUTLINES AND LOCATION OF ALL EXISTING ANO FROMS 0 STRUCTURES, AL LOCATION OF WELLS W HIN RADIUS OF ONE.UNDIIED iIFTV FT.ON <br /> NCLUNNO COVERD AREAS SUCH AS P *S,ORVEWAYS,AND WALKS. THE FMKITTY OR ADMININO FRUIRTY. <br /> slip- ,Pem-rtcA RJB <br /> Y,1�LA. <br /> X RCr�1ENT <br /> AUG 2 2 1995 <br /> z S tee NJQgour,,oo <br /> o <br /> CIT -NVIRONMEtHEA <br /> C 7H SERVICES <br /> � AL NEA!TH DIl'IS )M1; <br /> �lbl <br /> 0 <br /> m <br /> e_ o <br /> Cc <br /> N� <br /> ��1• � C v <br /> V a a Do <br /> I� Q too, <br /> FOR DEPARTMENT USE ONLY <br /> APRIUTICH ACCEPTED BY _ DATE: L <br /> S AREA: 'Z R <br /> ll <br /> T.,11 ON SUMP IM.TION 0Y GATE / / FRM INSPECTION SY DATE <br /> ADDITIONAL COMMENT.' <br /> ACCOUNTNO ONLY: NDF FACE — <br /> FE CODE FEE INFO AMOUNT REMITTED CHECKS A6 RECEIVED SY GATE M/RWIT MUTAS61 .—C." <br /> S $A5D,60 3-/3 16 Baa <br />