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I <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOIFREFURDARtf PFRIMT 13MMES I YEAR FRAM OATS ISSUED �I <br /> R:.IBPISNF 1.TTI mis) Pn 0-► <br /> AITLCATION IA HEREW MADE TO THE SAN JOAOUIN COUNTY FKA <br /> OR A PERNIR TO CONSTRT R INSTALL TIE R[WOOEBCI MSO.TNB APPUC T 1 LOMRJ. f, N SAN <br /> AAOLN COUNTY DEVDOM NY TELE.CHAPTER 9-11 10.3 ANO THE STANDAfON OF BAN JOAMIN MUNFY PIMIJC HEALTH SERVICES,EEMFIDNWNTAL NEALTN DMNION. <br /> JOB AOdEBI'WR A.°NI -- /% Mn 22 CRY------ �T� LOT SIIE � <br /> �Y ADOREee ! �( 7 PHONE,rp <br /> LOIfiMCTOR /✓,�Tj 7'�y� AOOIESS Z! C C I 7 - +T IlC/ L r PLMNE ✓�r <br /> WD CONTRACTOR AOOIEGB IIC/ 'l11olE <br /> TTFE OF S m WO11K: NEM IRITALLATHIN❑ PBAwAObIT OtETRI,X N❑ <br /> I.b NFRM: <br /> W--P"*TTEID 7F P.MM SEWER IS AVAXA X WTTHM 200 TTET OF BVMDINOJ PMIC TFITGI t 1 W W MRNXuy,y�A,y�,_ <br /> AEPNw ./_ <br /> INSTALLATION WILL SMW RF9!DENCfA COMMEICIAL❑ OTHER❑ <br /> NVMSYI-LIVING MTS:/_MLRnaae oP{[DIOOMS: NUNISER OP WAR v I: ! n ^u <br /> CTI' <br /> CHARAER OP EOE TO A DEPTH OF J FM:<�i RTIBULP SOA CNAMLTRI�ATER TARE DOT)(��00 MAR 1 lul i Y <br /> -0 TANI�TRAP ❑TYPEMF,T CAPA j'T NO.COAIPART¢ENTB 1,7 <br /> MID IIWTMERr 7lJINT D 01/TARC[TO MBAl1iuT1: WEIR FOUNDATION N10FERTY UNE DIS IC HEALTH SEWCES <br /> LST STANOM❑ nzt TYPE of M%0P BAND OR SEPARATOR IEN=02M eYSTEMI _ EWRO&NTAL HEALTH•;PASIGII <br /> LEACMNO ONE �Ho.S LEHOTN OP L1E6_1!-SIO /J` _ ABTANCE TO NEAPEST:uELL I by TOIINOATgN !O Fw ffly UW /D i) <br /> NLTM SED ❑MOTH LENGTH OMH "DANCE TO NEAREST:M ►OLAIDATION PIgPERTY UNE <br /> MO m �`��`T�EET❑fyyy���MDTD��-H �f LENGTH `-OEPTN OISTANCETO NEAEER: DL YYDL�r FOUNOArION_ PPE'"LINE <br /> B AON Mr. N L�/ SDE _NWBER�_"MANCE TO NEMESr:VNLJ p; fyOLLLOAT. C� FROPEITEY lINE1 dC7 <br /> IH~t t WROTH LENGTH Dl1T71 DINTA/PCE To NFA EST:WELL FOLBOATION PROPERTY LRE <br /> NPOBAI PONOS 0 RMTN LEAYTTN DEPTH DISTANCE TO NEACSr:WELL`_POUNDAT10N PILOPERTY LINE <br /> L HEREBY CEREIFY THAT 1 NAVE"SPARED MS APRICATON ANO THAT THt YAH(VALL SE DONE IN ACCORDANCE WrH IAN JOAOUN COUNTY OFONANCES ANO STATE LAWS.AND MJU- <br /> ANDAEOULATIDHNWT/EtANJOAOUNCOLMTY.NONlOWHEA OMUCFNSFD AGENT'S IONATYRE ClIRTBESTIIE POLLD N1E10:10EM1P1'iNAT NTMF POEOIMANCl OF TlE NOIKIOl1 WIECN <br /> TNS PMEAT It WNW.I SHALL HOT EMROT ANY FEiWN N SUCH A MANNER AS 70 SECOME SUBJECT TO MOIS[NMIS COMFOMATLON UtN OF CA vomA-'OOMRACTORS Mom M <br /> IJBCOHTRACTMO NQNATVRF CtITTVE K10110WI10:YCORIFY THAI IN THE PETEOFWANCE OFTNEMFK FOAVALICHTIRSPEAM 41SEUED.I NOU EMMOYFOWNS NLMJECTIO <br /> MOPKMAH'S COMPENSATION U1LV!OF MIA-. E AMUCANT MLNT nALL bI HDWLL M ADVANCB FOR AL:INECH"M NSPMW".COUKME DRAYYMO BROW. <br /> sgrEo z Tmf_ <br /> - � Z r <br /> OT/L,VP OF TO-AL"WALZ W- <br /> t.NAMES OF Nr1EEiS OR ROADN lENEST To OR BO OWG T� IIOPETTY 4.LOCATION OF HOLM WWABE OIiOSAL""M OR MROMN D <br /> I.q --IM THE PROPERTY,WRN OStg1B10NS ANO LGRTFTdRECTION. EXPANMON OP SEWAOE VIAMBAL WST/S1 B. <br /> J-MAIENIOIYD OVTLYEN AND LOCATION OF ALL FXIBTINI ANO MOFOSEO STMCWRLS. t.LOCATION OF WELLS WENN RAO"OF dE ALWOPI D NfTY FT.ON <br /> WLUDINO COWND MEAS SUCH AH PATIOS,DI"WAYS,AND WALIK THE MIOPOAY OR ADJONMO PROPERTY. <br /> �.I <br /> r 7. <br /> ` LS <br /> j <br /> t� <br /> APPl1CATpN ACCEPTED eY � �- -`� DATE: J O ( .A:Com• <br /> 11 <br /> TAMC,WOR SUMP INWT TION DV DATE I I PNAL MPECTION W DATE3 1 ZS'10� <br /> ADDRIONAL CONS0108: <br /> ACCOVI MIO ONLY: AOI FACS <br /> v co-A PEE-O AMOW:RO.YIT CIMCS/ICABN IOC - PATE ICJ MIIAII I <br /> I31 3 <br /> i <br /> Pub.HSStth St--EIrv110174("G) <br />