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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201568 <br /> (209)4693420 <br /> NOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IC.mplPt{Y Trip6{BWI <br /> IRIbATIOH I{NEKry MADE TO THE SAN.bAWM COUNTY FOR A MASAT TO CONSTRUCT ANDAP INSTALL THE WOO!DESCW6EO.THIS AFFMATpx I6 MADE IN COMWANCE WRH AN <br /> MAWIN COUNE"DEVFIORAENT TOLE,CHAPTER 9-1110.3 AHO THE STAND..Of SAN JOAODIN COUNTY MS.HEALTH SU VICE.,ENq NENMEMAL HEALTH dN6bN. 9 <br /> JOB WEBS, Aq APHI W COY �`W� LOT B�M,Ey,/�. <br /> BOB, <br /> xAME �/ �•/I '4 r3+`G a AooFEBS �-ZX'P'L-C / FHOME9l'7d140 <br /> CDNTAWTOR./f��Af/Q.'✓ rJ'�{.�;`L ACCESS. iZ/ P CTE t✓tCh% ^a'F�L uci Z2 plbxE �03-5 j <br /> MO CONTMCTOII AODR6. <br /> lMI OpNE <br /> —rm OF{EFRC WOW, FIM INSTALLATION pVAMIADgT1DN ."Emmom.❑ <br /> AND SEPTIC BY TO M RPMIFTED N MOM DFWfp IB AVAXABLE WOHd I.FEET OF BMLMNO.I V9N,T9Tb11 1 W W MANY <br /> I� MEKIAL MFEaMn i <br /> NSTAWMN WILL{9Nf: gE61OFKF Fd' COM ❑ OTHER E3 <br /> YVM[D1 DF WINO UXITX: / N11M{61 pi{EDROOME: MIMEII OF LMRO���;// <br /> CHARACTER OF DOM TO A Dff F OF❑3 FTYKRA4 " OT/SUMP BOIL CHAAACTIFII y �I �AkM WATE.TAM,DEFT" U <br /> FEFK TANRAIIFME TRAP <br /> C'W/`Cm NO.COMpAgfMENTB <br /> +NO TREATMENT PLANT❑ dBTAMCE TO MFMF/1T: WELLFOUNDATION FyF[gTY UN. <br /> LMT STATION O��PPB"T E TYPE Of NMF SAND OR SEPARATOR IENCLOBED"MMIJJ IT <br /> - EACMNO UNE ,W NO,E—1.OF LINES I�SAO� Z•ALI pIBTA1KF TO NEARER;WF11 ( D/ FOUNDATION �!O , ",Mp LINE <br /> DITSFO /L]WIpFEI LENOTN DEPrH DISTANCE TO MEANEST:M'FLL FOUMDATMM OpRRry IyYE { <br /> NDVNDm ❑WIMN LEHMH ANDD dMANCE TO NEAREM:KFLL FOUNDATION ROTERIYUNE LC <br /> Iumws MTF �DEFrH LE '36„ DEATH dMANCE TO NEAPEM:WELL llI `DOUN..x, , ppOMAIN'LNE l <br /> .."S ❑WI IrrH LENEEH DEPTH dMANCE TO NEAREST:WELL FOUNDATION pgOpfpTy 1Nf <br /> .."SAL IOXDE ❑WIDEN IENOTM pFprN dMAKE TO NFA.T:WELL_FOUNDATION EB, ST,LNE <br /> HfPEBY CEq"fYTNAT I NAVE FRIAKOTNB AEADCATpN AMD TOUT T WOK WILL M GONE IN MCOgOAKf N1TN SAN AAWIN COVNFY OPDMAKFB ANp MATE IAWB,NI0 gy1,6 <br /> WDRFOVLATIONS Of THEBANADAOVNCOUNTY,MOSEOMNEPOMUCEN EM'B.MNATUMCERTNIEBTKIF U WINO:"CEMIFYTHATNTHERPFORMAKEOFTHFWOKfO11WF H <br /> !MB" IT IB IAM I ANN <br /> HOT EMPLOY SAY RpBON N NCN A M E AS TO BECOME SUBJECT TO YAKMAN'B COMPENSATION IAWe OF CµlFOp11A,' CONTRACTOR-9 NMRIO OP <br /> I�IIgCOEET IO IATUM CFRTIFlfB NO;-1 CEMIFY TI IN ME RWORMANCE OF THE NOK fOp WIBCH TXIB TERM"IS ISSUED,I SMALL EMROV PEgBONB SUBJECT TO <br /> =K 'S COMETH. IA ALEMMIIA.- Ti A .T T C L N EpUO IN ADVANCE FOR ALL ISTENA ,IX{P TNM.. DOM -1 TOdMWNO BELOW, <br /> RG TO': DATE: <br /> ROT RAN IT OYW TO AEEA EM KALE <br /> 1.NAMES Of BTMETB OP ICAO. AEEST TO OR BOUNDING TNF RbRRTY. fe4. LOCATION OF HOUSE MWAOE DImOSAL SYSTEM Oq AESIMWO <br /> ].OUTUNE OF THE PIgRRTV,WITH DIMENSIONS AND MAIN DIMCTION, EXPANSION OF SEWASE UIMOBAL SYSTEMS. <br /> 1. DAUMBgNEO EXISTING AM AND LOCATION OF ALL EXIIANO ITOEOKO FIPUCTURS. S. LOCATION OF WELLS WITHIN AUDI OF ONE NUMAUD FIFTY FT.ON <br /> INCLUNN.COVETED ARAB SUCH A.PATIOS,dSVfWAY6,AHO WAEJT. THE MODEM OR ADJOINING F OBEOEF <br /> I <br /> FOE DEPARTMENT USE ONLY <br /> NPMATION ACCEPTED BY LI DATE: <br /> SAM.RT OP BUMP INFRETbN BV DATE / / PIAL INBRMpx BY DATE�/S <br /> ADDITIONAL COMMENTS: I <br /> CDUNTXO ONLY: AID, FACI <br /> FCODE I.E... AANUNTM HITTED HEC' MAFN PECIIVED BY DATE N/PFMIIT NIIMB91 IHVOIC6I <br /> �{I?•/� /�C %, FJ .73 - 'i__ c _ 73�� <br />