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x APPLICRTION FOR 1.101310 WASTE PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)4683420 NON•REFUNOABLT PEND EXPIRES IMAN FROM OATFIS§MFP IO6w bto be TrIpsma) APPLICATION IS HENE:BY MME TO TM SAN JOAOUM COUNTY FOR A Pawrr TD CONtT1MIC'F AmmoR BN[TALL THE wom DESCI[BED.TIES A"WAnft 16 MAOF w CDMMJANCr VMIH SAM joAauer cowl ncvELOPUWr TTL[,OIMfEN 0.1110.!ANO THE ErANDAPOE OF SAN JOAOURI eouwy pLvm HEALTH[6RVIGm W4wA IrAFTTAL HEALTH Elvis". JDe ADDIE6EAJR APNI ' WNS -_ f L+:YA'li lur ry112E �y�1 1 I l O 11.-6 _ CA �Q AOd1EBE •-}-c,'S.? F1101n� ,:i.- CONTFtACTOR 4%Uk, 1°"t[r(�.' Aoon>es "k do -'14 lmA +a � +Ia�E X3'3.777 3 2! BW CONDMCTOR AODRASS .1ce PHONE I TTPEOPED WOAt, HEW INSTALLATION ROAMAOMTION DOTRuerm 0 SAO SEPTIC SYSTEM PERMRTEO IF MOM SEWER Ie AVALLASIE hMTN1N 200 FEET OF BUILDING.) FL31C MTW L 1 MUM HMr1Y 1 ,// AppESEeP• INSTALLATIO11 WILT.SDN[: PmWMNCF.p CcMMEMAL❑ OTHER(3 NUMMI OF UW,M LMMS:_�NTSMSNI OF BEDROONIB:, TIlN4Y1 OF WFTAT67[: CHARAC'"OP GM TO A DEPTH OF]FEET: aht.(`i rTTMWP POLL CHAAACTEII: WATER TABLE DEPTH SEPTIC TANKANNAEE TRAP ❑TYPEAMFO CAPhL`Iry NO.COEDPATTTMENfe PMo►A[ATmmr RANT O DISTANCE TO 11ME[T7 WELL FOUMDATIOSIPROPERTY 1711E UPT STATmM 13 WN TV"OF PUMP @(A'IND OIL SEPARATOR IDNCLOSED EYOTEMI ' LL,.1CMMG UNE NO.&LENGTH OF Ume ( L U 7�Y�Fi 1 I'fycaeTANCE TO S.M.Nmu �J�7*FOUNOATGN-2—I ,•PUMA Y UNE 1--)r)f NLTDI am 0 WIDTH LEHOrH—awl-H D1ErANCE To HEAIIEST;LYE1.L FOUMOAT1OM PROMPTY LIME- D VJVTH IMEDVJVTH LENOTM_ oEIIM DISTANCE TO NEAREST:WELLFOUNDATION PraftRTY LSE AM WA02 NTS ❑DEMH MME NLMAStIi DANCE TO NFARW ENRI ELLPOIINDATIOM PRLTI OF7V LEE [LEAF[ ElworH LENGTH -_ — wT oEPrH DItTANcETO muuwffT:Lvul FOUNDATION . Pment YLLE DISPOSAL FONDS O WmTIK MOM—OEPFH DISTANCE TO NEAREST:WELL_FOUNDATION PMPERTY uNE I HEREBY CERTIFY THAT 1 HAVE MWPARu2 THIS APPLICATION AND THAT THE WOIEL WILL M DONE IN At C, A1TGE WITH @IMA JOACLIM CDUNTV OIOMANCES AND STATE LAWS,ATO FU ES AAO REWLATIONB OF THE SAN MAONIM COUNTY.HOLE 1799NNIORLILT3ISE0 AOENT'E&uNATUFE CMTTNILFTHE MLUWANO:'1 CERMYTHAT NTNEPEA OMAAINCEOFTM WOMPORNFIICH THEE PERMT It MOM I SMALL NOT EMPLOY ANY POISON IN SACH A MANLIER At TO VFC'OME MlNERT TO RIOMUAMS COMPEN[ATKM LAWS OF CALIFORNIA.'CONTMMTORTI"MIND ON MIS-COMINCTMO MNRURETCCRIMEB THIS FOLLOWM 1 CERTIFY THAT IM TIE P[TROWANCE OF THE WORN FOR WHICH THIS MImEr IS ISSUED,L YIALL EMPLOY SUBJECT70 VMFIKMAWO COWEN[ATION LAWS OF CALIFOIMA.` THE APPLICANT MW T CALL S•HOURS w ADVANOE MO ALL A GARMID IREPWTWM.COMPU ED11141M ND[FLOW. aDINED x TmL••,,,4r� T t'`�'�,'S r DATE: r' PLOT PLAN IDRAW TO SCALEI SCALE _'m . 1.NAIAEE OF ETIIETTE OR 01oADS NEAREST TO OR BOUNDING THE PROP[RTY. N.LOCATION OP HOUSE SEIVME 01111POBAL SYSTEM OR"KWOVED 2OMUM OF TIE FROT'FI M WITH DIMENGMM AND MOAT"DIRECTION. FJKPANMON OF wWAOE DmPVIAL BVBTEMS, 07"OIMEINODNEO OUTLINES AND LOCATION OF ALL LEM LNG AMD PROPOBUD STRIICTUMV, 6.LOCATIONOF WELLS WrMM RADIUS OFONE MMAIN ED Fi y FT.OH INCLUDING COMM AREAS SUCH AS PATWS.ORIV[WAYE,AND WALLS. THE PPoPEN7Y DN ADMPRNO FROMM, ... .... . .... .. :............. ...... ...... -..-- s - ..... , ... ...... .. ....,,...,......,,:........ - -. . 1 .. :.....:. .. ...... ................:... .z.. .i.....i. _ ¢... ..... ..... ,�� vn i. � '.............. OCT., .. ... 2+. v'UF.d-T.tJ 99$ - i. .; . ° .................:... .. //�� POR OEPARTMEMT OSEORLY j APPUCATNIN ACCEPTED BY Y.9J�f _ —____ _ DATE: �r �. M7EA: TANK,PIT OR SUNT M[PECTIOH BY DATE I 1 FINAL MBFECTION SY DATEa & ADDI'MMAL COMMEMS: I •`ACCOTBLMOONLY: Abe FAcr F PS COL[ I F.I. AMOONr.ITFO =1M. OATS SR r 02MM HuNAPM INVOICYP Ifo ,s o•le ,9 Pub.Health Serv.-ErMM.174(3198)