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Y <br /> APPLICATION FOR LIOUID WASTE PERMIT -o 1cz <br /> SAN JOAOUIN COUNTY PUSUC HEALTH SERVICES Q1a <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)488-3420 <br /> A04AEFMMOLE PERMIT EXP4RE'1<}YEAR FROM DA71115IED <br /> Kox*k a M 7toildsw <br /> APRJCATON hT"MILW MADE TO THE SAN JOAQUIN COUNTY FOR A POW"TO CONSTMICT ANWOR INSTALL THE WORK I ESCINNIM TRW APFUCATION N LINAGE IN COMPLIAM6 VATH SAN <br /> JOAOUN COUNIY pE4LLOPMt9fT TTTM a"nER*-11)0.3 AND M STNOAADG OF MN JOAOUEN COIMTY N1WC HMTM SOWICU.INIVIADIM[MfAL MAL M DMEIDN. <br /> JORAOdROSMA A^N/ ."�"1`-!� K l� —crtY eN107 ' (fi�- wT 41M <br /> OWWMM MAAE•,}r�ZZy'q�-^n 7 FIs 1AVMM <br /> coNTRACTOn _ c` AODIIESE_ <br /> MMCONTRACTM ADOMSS UCP <br /> TYPE Of orpm 1Y011R MEW MSTALLATION❑ IEPANVAOMM MEIY MPITMNCTION❑ <br /> ONO UWM SYITIEM HRASTTED R PUBLIC WWER IS AVAI ASLE"THIN ZOO FEET Of VJKD#4.1 FT97C TltTb 1 1 IYJMI SUINT <br /> I APAAP4P I <br /> IMITALLATION LHWL SEN[ fS?SNCOic"I3 COMMMLAL❑ OTTER Q <br /> 101MM I OP WANG{MTS: _/_ _.AKMMlk 11 OF Sf01MI*w:,� M AMM OF OAf OYm: <br /> CHARACTTR 01 SM TO A DEPTH Of l FM: /-ja en FTTKNAP SM CMARACTM WATLR TAWS MMit _ <br /> SgTIC TMxlWISAS[TRAP ❑TYPEITAFO G`ynC,IZG CAPACfTY ND-COWAim WTO v" <br /> ` PSO TIIUTMEfIT PWAMT❑ INSTANCE TO MAPMUIT: WELL POUHOATION � PPOPERTY LtA! /(TSI <br /> L/T STATMN❑ ETZE TYPE(,'*PUMP SAID OL SEPARATM 01CLOM0 SYSTEM <br /> IIAORNH MME ❑ NO.A LEPIGm OF WINEB (� c)C, aATAINCE TO NENMST'WELL P0INDATION /e f� PROIKRTY 111[ <br /> MY"DID ❑WSTTH tomrTH up TH OMTANCE TO IEAEET:WELL_POUNOATION fMFEMY ME <br /> MOUHOID ❑WOTH WLTLOTH 09TH OMTAMCE TO MEANEST;%WA -FOUTDATNM PROPINTY LINE <br /> szv%L PITS ❑DEPfM SQE —NUMSML DMTANcE TO NtAmort vmL FOUWAT70N FlOFOIP/LSIE <br /> SUYFS ❑H90TH LEMS'TN DEPTH INSTANCE TO FWEn:WELL _FDUMAT NV PROPOITV LIE <br /> DMPDSAL raw" ❑WIDM LE MTH •OWFH DMTANCE TO NEAERt VAU--FOUNDATION FROPO"LIME <br /> 1 HEIESY CTRTIY THAT t HAW POWARM TIRE APPMATION AID THAT THE WOIK WILL.EE OONE N ACCOTDANCE WTM 7AN JOAOLAM COUNTY OIOS/NCM AND STATE LAWS.AND MILES <br /> Nb 1EOlIATIONF OP THE SAM JOAa1W COLMTY.IOMEOVVN[TIMUCB'ISED ASINT'S SISMATUPI CERTEAES TMEPOUDTNSNOt 9 CpRIfYTNAT NTNEiNSOfMEAMCE Of T{Il WOIK fORMRSCN <br /> TNM POSAR IS"AlIl I SHALL LOT 9S11O1 ANY PERSON N OXII A MAI.AS TO SPCOME SUSJECT TO MgIfLAMPY.COSMEMMTION LAWA OF CA110010.•CONTIIACTOR'S NMS OR <br /> EUR4=%-RACTINO SIOMATJPE CM1TIFIES THE MLLOWNO:7 CEHTSY THAI'N THE M.PFOIMfANCE OF THE WOW FIYA VAMM THS PORMT IS HOUI D.1 MAIL NPROY PIMMO t SUdJgT TO <br /> WOMMAHM COMPE1' tON LAWSOf " <br /> MANSIOAM ANMT CALL K MOW N ADVANCE POR All.14101110M INMOTMNS.COkwuTT D1HY494 9tWW, p <br /> 90.11D 11 '71y 'I—I'l I I <br /> 1 <br /> PLOT RAX OMW TO SCALA SCALE--- <br /> I- <br /> CALE —I. EE <br /> MAMFS OF STITJ M RME ONEAREIT TO OR SOIRIOSIO THEPOPETITY. A-LOCATION OF MOUSE SMAOE DISPOSAL EY9TE4 OR PIOPOSED <br /> 2.OORME OF THE F OPEIOY.WHTL ORAM WONS ALA NOIRM ONFCTON. EAPANOM Of SMNAfEE DIROSAL SMM". <br /> O-Da"600WO OVTUARS AND LOCATION OF ALL EXMMNO AND PROPOSED STRUCTUFES, i.LOCATION Of WELLS WITHIN FNOIUS OF ONE IRAIOP®HAY FT.ON <br /> 1 0 CLMOM CMUM MEAS SUCH AS PATIOS.DRVEWAYS,AND WALLS. THE MOM"M AOJOIANS FIOPOITY. <br /> � o <br /> ... <br /> n. <br /> ...,,. ..... ...p.. ... .... <br /> '.............:.....:.... ......-...:..........:......' ....... ....:..............:. <br /> _ <br /> .........:. <br /> 1T <br /> �1 <br /> ..._ .. ..... :.....:.. ... .... ... <br /> POLL OOAATMBIT UYOMV <br /> APPL)CATION ACCEPTFA <br /> TAW,TTM VUW INSPECTION BY DATE I I FINAL tnaP[cTDM SY LUTE• ? f Co 1 T <br /> AMITOMAL CONMWTS: <br /> ACCLHJItIU'O ONLY: PILI FADE <br /> RCC" PSE INFO Mf %Pff MBS MD CMIWMASH PTOCOVED SV DATE SIL T romw NWRISSR - INVOICSP <br /> 4-Lf2-!o !IS iro- .v Sseoo/ �7 <br /> Pub.HwttlN SrrfY•EtlLdro.174(3198) <br />