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APPLICATIOM FOR LIQUID WASTE PERMIT � <br /> SAU'JOAQUIll COUM PUBLIC HEALTH SERVICES <br /> ENVIROCRIEVAL HEALTH DIVISIOU <br /> P.O.BOX 988,304 EAST WEBER AVENUE,STOCKM4,CA M01-M <br /> 1200 400-3420 <br /> UOD•REFUGDRlLE PERE7R EXPIRES 1 YEIID FDDFI DATE 188Ml <br /> (Ciegdta b TrbDTola <br /> APPLICATION/0 HERESY MADE TO THE SAN JOAOUM COUNTY FOR A KNEW TO CONSTMICT ANOWI SMTALL THE NOME OESCP ED.THIS APPLICATION It MADE N COMPLIANCE WITH IAN <br /> JOAOUN COUNTY DEVELOPMENT TILE CHAPTER 9-1 10.3 ANO THE RANDNTJN. <br /> JOS ADORES0R APIIE041VP <br /> ` CRY <br /> OTMIEMIS NAME CJ OL\- _ AOOMS0 pp/me <br /> CONTRACrOR���d7lrl ADDIESS� / UCI�/�'T Z�f PLpNZ <br /> FUO CONTRACTOR AoDnEft LIC/ RIOPE <br /> TYPE OF/110I11C WOKE: REIN MSTALLATION I] RVAUVADDm DISTINCTION O <br /> NO SEFTIC SYSTEM PERLAITED N PLIOLIC OrMR IS AVADAME WRHN 200 FEET OF M"M.1 P=TESTW,1 1 NOW MANY <br /> APp.SfRlw <br /> WSIALLAMON WILL SONS: REeMNCEX COMMERCIAL O OTHER <br /> NISAOI'a <br /> OF UVNO 11MTi: I MU4M79q OF S S:�N1/i1301 OF DAPLDYEW: <br /> �C OF BOIL TO A DEPTH OF 3 FEET..,& SOIL CNARAC'"M: WATER TAME DEPTH t� <br /> 11 M'J0 LASS T1W 0TYPEnAro.0 CAPACITY p NO.COIU./ARIMENri <br /> EKG TREATMENT PUNT❑ DISTANCE TO NEARE7T: WEA; r_..� FOUNDATION SCS ! PROPERTY LRR <br /> UFT STAmpt❑ au TYPE OF FIR,IP $AND OIL SEPARATOR IENCL00ED SYSTEM <br /> LEACHING LOIN E] NO.•LENGTH OF LNEll_ DISTANCE TO NEAREST:WELLPOUNDgTgN PROPERTY LINE <br /> PILMr r <br /> MOLMI W �^ WIDTH LENGTH__DEPTN�.I. gOTANC[TO NEAREST:WELL G f FOUNDA O�f PROPERTY UNE_r�0 <br /> MOUNOgI D WIDTH LENOTN _DEPTH DISTANCE TO NEAREST:WELL _FOUNDATION PROPERTY UNE <br /> SL'7A02 IRS O DEPTH fLZE NUMOER DISTANCE TO NEAREST:WILL__FOUNDATION PIOParTY UNE <br /> VAOM O w1OTH LENOTH DEPTH DISTANCE TO NEAREST:WNL_ FOUNDATION PROFERTY Log <br /> DIOF00AL PONDS O WIDTH LENGTH DSPTH DISTANCE TO NIAR[ST:WELL_ FOUNDATION PROPERTY LINE <br /> I HERESY CERTIFY THAT 1 NAVE PREPARED THIS APPLICATION AND THAT THE WORK WRL DE DONE N ACCORDANCE WfrH SAN JOAOUIN COLNRV OID01ANCE0 AND STAT[LAWS.AND RIMS <br /> AND PEOULATKWM DF TTE SAN JDAOLRN COUNTY.HOME OWNER ON UCENWID AODR'i SMINATLOM CERTEM&THE FOLLMWM.'ICERrWTNAT N TMP[I 4DM&4"M IM%DMK FOR VA40CH <br /> THIS PERMR IS IOSUEp.I(HALL NOT EMPLOY ANY PINION IN OWN A MANNL\AS TO OECOM2 MWECT TO WDFAMAWS COWMATDN LAWS OF CAUFOWAA.• CONTRACTOR'S"MM OR <br /> SMCONTRACTNO MONATURE CERTMIS THE POLLOVYM:1 CERTIFY THAT N THE PER PON AANCE OF THE WONT MR MOM THIS PEMAMT 10 WCM,1 CHALL EMROY PERSOND OJMMT TO <br /> WOR( INDUAT10N LAW OF CAL.NOINIA.' TM APPLICANT MUST CALL IF NOUM N ADVANCE PON ALL=01Ctb N/OPCCTIONO.COMILETE CMWSTO DHOW. <br /> CIO/ED TRIL: DATE: _O <br /> PLOT PLAN DRAW TO OCALEI SCALE <br /> 1.NA / S OR ROAD/NEAREST <br /> METO OR DOUNDNO THE PROPERTY. .,LOCATION OF HOU82 C@WACE DISPOSAL SYSTEM OR PROPOSED <br /> 2.OUTLINE OF TIE PROPERTY.WITH DRFFNODNS AND NORTH DIRECTION. EXPANSION OF IMAGE DISPOSAL SYSTWM. <br /> 7.DIE4NHOMED OUTLINES AND LOCATION OF ALL OUlTR10 AND PgPOSW oTMICWMS, 0.LOCATION OF WELLS VARKM RADOM OF ONE NUHORW PARTY FT,ON <br /> NCLIIOM0 COVERED AREAS/UCH AS PATI00,DRIVEWAYS,AND WALXS. THE PROPERTY <br /> AOJORCMi P110023147Y. <br /> ..... . <br /> � mt <br /> l -rLTL. <br /> +z-`fie <br /> ,yam <br /> ' r ' <br /> ol.' �� .;�.�.:�� . .......................... . <br /> 61 <br /> MN <br /> : ..:. E: . . . ;-MPw . <br /> S �s <br /> QMN�jHP\N-. <br /> . ......................:...........<.._.._._.�N ..5"..........°_. .. —T . <br /> FOR DVAMMENT USE ONLY <br /> APPLICATION ACCEPTED SY DATE: A1EA:A(�7g,�� <br /> TANK,PLT OR/URA.'INSPECTION BY DATIF5 ILo 10c> FINAL INSPECTIO DATE 1 0r- -7/{ I pe! <br /> ADDITIONAL COMMENTS: <br /> ACCOUNT1110 ONLY: AIDE FAC. <br /> IJ COD! fQ INFO AMOUNT RDNITTFD CIMCK/ MH RECEIVE))1Y DATE SIR I P00tlST MLEWCM INVOICE/ <br /> F t Aft I/�' / GA) On�7►R �. / / =7 em. ,/,�IA/t, c)ar R If f A � <br />