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EFr APPLICATION FOR LIQUID WASTE PERMIT 6� olQO Y y O <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES l <br /> ENVIRONMENTAL HEALTH DIVISION 0 f/ <br /> P.O.BOX 3881 3D4 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> 12091 460 3420 (. ( J- <br /> RON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1• w_...e A <br /> IbmpinM in Trglintnl <br /> APPIKATION I6 NEARBY..1 1.THE SAN.00.....FOR A FEgMD TO CONSTRUCT AND/OR INSTALL THE WON(DESCRIBED.THIS APTUCATION IB MADE IN COMN/.WCE WDH BAH <br /> JOAOUIN COUNTY OEVELONAENT TN)IE,CHANO <br /> BEER 8-1110.3 ANO THE STAARUE OF SAN JOAOUIN COUNTY PUBLIC HEALTH/SEWCCEESS.ENNRONMMS <br /> ENTAL HEALTH OpN. <br /> JOR AODRE IIAH•/A(/FTNS�� ,2.y q ':3o �/w y 9�9 CITY `J' LOT S13E•F✓ �Y <br /> OWNEA'9 NAMFlEtifCAM1� ��LA�E�,E. �VL�. AOORE68 /// W iH01$ ��- ((6/ <br /> CONTRACTOR 6 AD.E86/ I ( ,+/� /! / TICS /�'/ FROM 1/ <br /> W...NTMCTOR ADDRE6H Z( Z�C''At LGC It S4, ��IL LKS V022Y-..EV <br /> TYPE OF tEBfIC WORE: XEW IXSTAWTION gFPAWAOpTOX❑ mO nvCTIOX❑ <br /> 1.SETTK SV67EM FERMRTED IF FURM.E l IS AVAMME.1H E00 FEET OF B Ul...l PESO TEST1.111WW M14N1 <br /> /, AppPutlen I � <br /> INSTRLLATON WILL ipVE: RE6NENCE❑ COMMERCIAL THEM❑ <br /> s01 DIP xp UMTP:_xUNS91 DIF gEglpOMi: xVMS91 OF B,ERrorYVt4�: I JOAUUrN COUNT, <br /> N� T OF IL TO A DFPTN OF 3 FEET' T NT/BUMP IL CHARACTERL WATER TA&E OEBNI �fy� 'o6L C VIT IIRVICE: <br /> TC TAN EASE In. ❑TVFFMFO SW-P GARAGE' IDI.CDMPARTMEATB 1.. AI HEpIT4lI\S'jlLi <br /> TMEMT KANi I1 DILL...TO NF/1MlT: WELL O� '� FOUNDATION �, L NbFIATY LINE Zj / <br /> SS UFTSTATION S TYPE OFFJMhW SAND OM1 SEPARATOR(ENCLOSED SYSTEM( N _ <br /> LFACHNO UNE NO.IS IEHOTH OF UNES Y LAO' I f A(Cg DISTANCETO NEAREST:WELL i5:0 4-FOUNDATIGH�MJKRTV LINE 5 , <br /> MID,Bm 11 DT. LENGTH DEPTH DISTANCE TO NEAREST:WEIl FOVNDATMN FROEERTY EINE <br /> MOUNpFD Q..TN LENOTI DEPTH �2 DISTANCE TO NEAREST:10111.10111. FOUNDATION PIMIERIY UNE <br /> SEVAOE BIT. � �JH C-SE StIE 42-4 HUMBER J DISTANCETOHEARR:WEL I-'(D FOUNDATION FIOFERTY me <br /> LUMpi ❑WIDTH URNI DEPTH d6TANCE TO NEAREST:MJELL FOUNDATION FAORgTV UHC <br /> 0I6Po11AL PoNOS ❑WIDEN IEHSTN DEPT. DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS ANVCATIOH AND THAT THE WOW N%L-BE DOW IN ACCORDANCE WNH SAN MADDEN COUNTY ONNN/JICES AND STATE(AWB.M.PLUS <br /> ANOREOULATpNSOFTHESANJOA IM COUN V NOMEOW MORUCENSE MA W'SSMHATUMCERNHESTHEFOUDN'IND:'ICEgTX AT NTNEFE%OPMANCC LIFERS WOW FOPNMICN <br /> THIS PERMIT HI IBNEO,I.1 T R_Yr <br /> V ANV MR_.IN SUCH A MAHNG AS TO BECOME NBJECT TO MMMAN'S COMMNSATMN LAM OF C.WFORIAA.' COMPACTOR'S MINING OP <br /> SUBLOMMCTING SIONAT CEM(IES THF FOLLON'INO:'I CEIrtIRYTNAT N TM MRFONAANCE OF THE WOW FOR WFWCH TMS PERMIT IS ISSUED.(SHALL EMROY PERSONS SUBJECT TO <br /> 5 Cow SCOMPEN6 ON(AWB FLALIFORNIA.' TNF AIPUCAXTMVST CALIXNOUIIS IN ADVANCE F0111LL gFOUPED INPHCTONB. COMIEFTE OPAWINO BELOW. <br /> SIOHEO% TRLE: I�- DATE: <br /> rtoT PLAN IIXRAw TO SCAIF]MALE <br /> 1.NAMES OF STREETS OR ROADS NEAM6f Oq BOUNDING THE PNOPERTV. IFS.LOCATION OF HOUSE BEWAOE OIGMBAL SYSTEM OR PROMEEO <br /> E.O VTUNE OF THE PROPERTY,WITH DIMEWRNS AND NORTH DIRECTION. EXPANSION OF SEWADE DISPOSAL SYSTEMS. <br /> J. DIMENSIONED OUTLINES AND LOCATION OF ALL E%IST IG AND FROMBED STPUCT VMS. S. LOCATION OF WELLS WITHIN MFIFTY <br /> ITHIN RADIUS OF ONE HUNDO FT,ON <br /> IM WNNB COVERED AREAS SUCH AS PAT..,DRIVEWAY.,AND WMIIe. THE PPOPERTY 09 ADJOINING NIOMRTY. <br /> �yC121, � N <br /> SGS J S <br /> 3 �:W� <br /> ' Dj \"KC P <br /> 5�4- �9-6oz2 <br /> S o FOq OAMTMpT VSE ONLY <br /> APPLICATION ACCEPTED BY P.,1.4.v�R,X, CO J_L DATE: � A: <br /> TAW.PT OR SUMP INSPECTION BY (i DATE I / NRAL INRPN,T, V TE / C n <br /> / <br /> ADDITIONAL COMMENTS S C. <br /> uv <br /> ONLY: AID# <br /> `) 1I <br /> PE CODE FEE INFO AMOUNT P0.11TTEO 4/CA6X I P pR V T MIPFPAIIT MLMeB1 MVOICE# <br /> Z 5� 2 a 0 - 56-31 <br />