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APPLICATION FOR LIDUIO WASTE PERMIT <br /> SAN JOAC =NTY PUBLIC HEALTH SERVICES 4P <br /> ENVM"MENTAL HEALTH DIVISION <br /> P.O.BOX 388, 446 N.SAN JOADUIN ST,STOCKTON,CA 962010388 <br /> (209)488-3420 _ <br /> NOMREFUNOABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IC.YPIBM V TrVOmMI <br /> N9lICAT10N plMppy MF'DE TD TXF WI JDMIXN CDVNTY FORA PERMIT TOCON6TNCT AND/OR INFTALL THE WOR(DEWSRED, THIS MV MN M MADE N COMRMNCE PUSH,B N <br /> 'M)ADUN CO INTY DEYIIDAD?M TRILL.CXAPTEq&1110.3 AND THE STMIDMOB OF SUSH gAgIW COUNTY MI HFN.TH BERNCEB.FNNROHMEMµHEKTX pMFM)rI, <br /> +. ADpgFDBMq ARM 19a9d We=t Tn clrr Lodi <br /> LET=EAcres+ <br /> ,6iii,IEwexA k Lloyd Yenokida AD . P.O. BOX 856 Lodi, 95241 476-9649 <br /> :oxrRAer.R Morton Septic ADURB. 121 E. Churchill St,StkueP 444225 gpryE 463-5343 <br /> COMMCrdI ApglEgp LKP PHONE <br /> I'IE DF FVTID wDgN: N.MTA m.fS wmmmuanoN❑ FMBTNUOTNND <br /> NO 6EPq;SYSTEM PFAAUTTFD IF PUBLIC BgSER 16 AVMLABLE W1T1RN SOD FEET OF BUNONG.I NYC Tyrol I I NDw MMIY <br /> AP/sBm L <br /> I ALLATNIX WILL SERVE: RESIDENCE 1% <br /> LY COMMFNCIµC) OTHER 0 <br /> _ nq DF UMND UMT. 1 NVAgq DF BiCNDOMS: 3 xlMq OF WNDYm. <br /> :HAMCTEg OF SOIL TO A DEPTH OF S FEETSnIRTMUMP p4 CHM M._2lay 10 a M WSE,TAYL DOTH <br /> IEPTC TANXIMMA.E TRAP MTYPE/MFOconcrete PSL c"ROrr• 1200 oL1 ND.CDMP,NT,Iq,TF 2 <br /> TIFATMFIR I4NT❑ gBTAMCF TO NFAgNT: WE11 7 o I PoUNMMN 10 I PROPERTYLWE 1—OO, <br /> LIFT 6TSTOX❑ 6QF TYPE OF NMP 6A1q)04 SEPARATOR IENCLOSEO SYSTEM) <br /> u'CMHO UNF M ND.a 1FxOTH OF LN¢6 2/6 5 1 tin e s DISTANCE TO NEwgEST:WTu 1 00'+POUNDATS k2 9' R,,N T,,UNF2 0 1 <br /> RT.WEI 13 NADTN LFNOTI pEPTH g6TANCE TO NEAREST:WELL FOUNDATIDx PgOFERTY ME <br /> MDED <br /> 13 WIOTN 1LNOTX OFPTX gSTµCETO NEAREST:Wp1 fOVNOATION TOPFgTY LWE \ <br /> AOE RTF ®OERTX25' FLII 36„ NUMBFA�_gBTMKE TO NEAREST:WU1150'+FDUNOATCN B 0, PRDPEpTY INE 1 0 1 �� <br /> PSGS ❑yMTX LENGTH DEPTH geTMICE TO NFAPLST:WELL_FOUNMTpH_PROPERTY ME <br /> 00OB410MOB ❑1NDTN ILNGTN OEPIH gFTANCE TO NEAREST:WELL_PDI TION PROPERTY,UNE I. <br /> My CERTIFY THAT 1 HAVE PREPMFD TMS APRICATCN AND THAT THE MRS WILL BE DONE IN ACCORDM E w H SAN JOAQUW COUNTY OM—D)AND STATE IAWB,M1p NIEB <br /> LFGUUTpN6 OF THE SAN.gAWN COUNTY.HOME. <br /> MENSED A0ENT'6 SXINATURE CEglXEST1E FOL WHE:•I CERTWTIUTNTHEIFAFON.INKEOF TNEWOiN FOq WX1Cry <br /> FFMAR IB ISSUED.I GMLL HOT EMPLOY ANY PERSON IN SUCH A M NER AS T==W CT TO MVYLMMI'B COMPFN6ATCH NM90F C ERIDIR lA• SSf THE RK HNBNG H <br /> U6CONTRACTING GGNATUK CFATIFIf HE WINO:•1 CFATIFY T A W THE B OF THE YbRL FOq Wl11CN TNI.PFAMO I81B8UFD, SHALL FMPAY PERSONS BUSIER TO <br /> IOKKMAx'S LPU 1 WSOFC fOW T MBM My.SA,lg ApyANCE 1011 MLIIEOWIFO INSP¢TIONB. COMPFTFOMWIIWOYER <br /> 9X TTTUO Contractor DATE: 6-7-95 YI <br /> MUDY q NMI TO 6CALO SCALL <br /> NM EB OF STREETS OR NAD.NEAREST TO Oq BOUNDING THE PROPERTY. •NA.LOCATION OF HOUSE SEWAGE DISPo6M SYSTEM OR M,.OUTUNE OF THE PROPERTY,WITH MMENUMS.MD NORTH ESK TS N. EXPANSION OF SEWAGE DIBPo6M SYSTEMS. r <br /> MENSMNEO OUNNE6 ANO LOCATION OF ALL EXISTING MO PROPOSED STRUCTURE., 6.LOCATION OF MLIS WTTHW MOIV60F ONE HUNDRED FIFTYFT.ON <br /> :WdNO COVERED APFA6.ULH A6 PATIOS.DNVEWAYB.ANO Y... S' <br /> WAPETT'OR ADJOINING PROPERTY. <br /> T <br /> 2S 7L <br /> ,t <br /> s, <br /> LRF.,�EdlA __. <br /> JUN 9195 <br /> FL2LC HEsLTH SEAVH>ES"" <br /> ENVIFIOYMLNTAL HEALTH DTVI& N <br /> E� FOR DEPARTMENT USE ONLY <br /> ATwN ACCEPTED BY ` G <br /> oATE: AgBM Q <br /> iK,PN Oft SUMP INSPECTWN BY DATE I I FNµINBHCTpN GAIL / <br /> `-ONAL COMMENTS: <br /> LCCOUNTING ONLY'. Mp/ FACR <br /> :'RODE FEE INFO MIDUST REMRTFD XF ASH pELGyID gy OATS 727 IN/V�pCFI <br />