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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.U.BOX 3M Sot CAST'WEBER AVENUE,STOCKMK CA 95201-988 <br /> 09)48t.342U <br /> NDIE RE>:UNDAPLE PEZWT COW 1 YEAR FROf DATE tSSUED <br /> 1CfgIfFl Y Tr*km 1 <br /> AFRICATTON 10 IIN'RDY MAO[TO TWO SAN JOAOIIM COUNTY FOR A POWR To CONfTRUCT AND/OR INOTALI TI!WOW OEIMCM 9 TIM APPIXATION 1/MADE IN COMRANICE WETI SAN <br /> :�,• JOAQUIN COUNTY DrAl.0DMENFyT nX CHAFTM 0.1110.3 AND THE ANOMDB OF AM JOAOUM COUNTY FVMX:HEALTH MWACM WW"OMRMx HMTW DTVN10BL <br /> Jof AOOIEffXR.WI/ f 2 ro wtl , CFFY ✓ <br /> ' Lai <br /> oPeml'f NAME AODREM PHONE <br /> 1 caNTlucTon T��DDIeEse 1 fin+ �tN✓I .1 �?/3 5C, t s+FONE ;71 — <br /> J'a <br /> sWill CONTRACTOR AOOIEfe Llcr PFIOI/ <br /> T m OF fVTC YTOW MSW MfTALLAYMN❑ IETASUIIOtfTION DOITg1CTMM❑ <br /> f10 wvm fYIIIEIA PERAHTED Sr.K MIC SEWER 18 AVARAM.E W?MN 700 FETT OF SUILDMO.f EVIG RLThI L I NOM MANY <br /> Y <br /> AIfiFAfyr/ <br /> 1PTfTAWTgR/ALL fU1VE' fj[TiOF710E 19 COM WAAL❑ OTHEH EI <br /> TFU%GW OF UVM6 UNIT{: / NSM-NMR W t OOAY: � NUMIMI OF EMPLOYE$ <br /> : <br /> F CNARACfat OF 11011.TO A DEPTH Of]FEET; 1'RAUAM BOL CHMACTEh.�(?,�faJWATFJI TABU Df1fT1 <br /> SYTFC iwwflVlSAff TRA► ❑TYPEl " <br /> CAPACITY M.COMPAR77.E11T'1 <br /> v Pyre"IFATNNFT TIANT O ONITAMCE m N6M.fT: NQL, FOUNDATION PROPERTY IWE <br /> UFT OTATLON❑ 81iE TYPE OF PUKW SANG OIL SEPARATOR KHMOBW SYSTOJI _ <br /> LKACOOM La No./,IEIOTIS OP L1HE '�O DISTANCE TO NPAIEBT;V&IB. PD\AIbATgP1�y9NOWEN/Y Lox, t:�, <br /> FKTVI SEO la VVIOTII _LENOTH OEPTH OSTANCE TO NEAREST:WUX FOUNCATION PROPNITY LINE <br /> MOISAM ❑NIOIH LEIMTN__OSP- 0WAHCE TO HFLFMS VV LL FOVWWM1 nom PROPERTY LJME <br /> fEWAOf FTTS E]OEM fNa NLAIBEA DISTANCE TO F•MAFIEW:WELL PoIKdAT10N PIIorERr•r LIAN <br /> I fNRIf (Q-TI IYIDTH Z- L9gTH DEPTH '7TFA <br /> .-TANCE TO NMIBT:WTU -I&.)_PO'.MA7ION PIIOF[45TY LFL <br /> •1 01iPOSAL MAW y tAfOTiI LDgTN DEPTH DISTANCE TO NEJJRIT:MU FOUNDATION PROPER"LK <br /> 1 HeREW COREY MAT 1 HAVE WWPM[D THIS APFIICATION MIO THAT TNT vmw WILL SE DONE M ACCO/OANCE PRTA",.;OAQVW 0""OMINAF CW AMC STATE LAWII.AND ANTI" <br /> } ANDWMRATFOMOFTFESMUJOAOUMCOUNTY.NOMEOWNEROM1UCPIJSED ADnmSf10HATIFIIE txmLFIEBTIE TgyOVyfq•.'ICEkRFYTWATMTNEFEIIPORMANtlOAMWOIYCFOIIWFSCN <br /> TNM PEIEATT M IMU M-I"HALL NOT"MARY ANY PVt$ON M eUCH A MA WER AS TO SECOAE W WWW TO WUFfCLMN'f CTiF:MLNMfpN IAWf OF CALiOgilA.'OONTRACTdt'f/MrAf pR <br /> { SUa COMRJCTMO SIONA CERTIgES TTiE FOLLOWZWq 'I CERT/Y THAT IN THE P91POfM g OF THE WORK FOR~ICH MS PFNMT M WIN".1 fUALL EMPLOY PEMNOM IURACT TO <br /> WOPKNIAWS COMP04QA LAWS OF CALIOIONA.' M APPUCAMT MUST CALL S4 WA M IN ADVANCE POR ALL MO'JWM 1NAMCTWNf. C01000,rM ORAMW SODW. <br /> } <br /> IfONEDx TTTLE: o(wJ 9L Y OATS ZZ_�Z rf� <br /> PLOT RAN MO;AW To fCALLI SCALE _`q <br /> f.WARS OF SITEETTI OR ROAM NIAIIST TO OR M4Nd40 M PROPERTY, f. LOCATION Of NODE MENAGE O 09AL FfSTIM OR PIOPO@W <br /> 2.OUTUME OF TW Pn-W TY.WTH OM M MG AND NORTH OWcmN. EAPANf101T OF fEWAOE OISIWAL SY'dEpf; <br /> t A ORTWMOFED OUTISJEf AND LOCATION Of ALL PJOfTSJO AFO PROFOBEO STR/ICTIl/1Ef, S.LOCATION OF WELLS 1ATTIRN RAOM OF OW HUNDIB O FW"FT.ON <br /> MCLUOM{00%Vq LF AM"MICSS N PATIOS,ORIWWAYII,AEA WALKS, THE PI MITY OR ADJOWN"PROmmY. <br /> :.... . <br /> : <br /> .7.. ................ 5..... ....• ... <br /> y <br /> C <br /> L <br /> .�. <br /> ....i....�......,...j.. ..o.....i... .i .j.... _ 7 <br /> ..:......6. <br /> ....>......;..L..... i <br /> ...`... r... -. t '......`.....b. <br /> ..,:.... 1 . <br /> .. . <br /> ......... . 0:._. <br /> a <br /> ... .Y....... <br /> r <br /> r ...n. <br /> If 4 <br /> ....... ... - ...... .. <br /> ... <br /> ..I....o-.... <br /> 9 <br /> FOR DEPAFfTMBN7 L11f 010.Y <br /> AFPMATION ACCEPTED fY'_ DATE: AFFA: <br /> TAMC.FET M S 4IBRC7TJN SY OATF 1I FINAL INfPMTION AY DA!E <br /> NWWrK)NAL COMMENTS: <br /> ACCOUNTING OMY: AXP FAG <br /> M COOP Fi1NF0 AMOUNT 01111AT1TED CHM"MASH RECEIVED SY <br /> DATE fM1 IFlAfT IIUAIll41 SAy01OS/ <br /> WJb.4%llft 84tY.-Enviro.174 pme) <br />