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,o SIP ools7� <br /> APPLMATION FOR L10U10 WASTE PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES v <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 85202 <br /> (209)4683420 <br /> NowwyNDAPLE PEAR EXMOR 1 YEAR FROM DATE NI VED <br /> KngkI.IS Trolmo611 <br /> APPLICATION 1A H VF"Y MADE TO THE SAN JOAOUN COUNTY TON A PE ROT TO CONSTRUCT AMOR INSTALL THE WORK DEBCIIMD.TNI APPLICATION N MADE W COYPUAIICC'WITH NAI <br /> JOAOMN CONAVIY OEIROFEIEJ IC TTrrFMl.CNNpTEA 9.1110.!MA MII THE STANDARDS OF N JOAOUCOUNTY RMUC"MTN KRVICE&ENV9gM�TAL HEALTH DmIllm. <br /> JOB AOOIE6B�OR A.'NP J 1 1 As" d -Cr" c Ozi'-r- _ lJT an- ".�Yj� <br /> oWIER•I wvMe_��r`.rte- .� t,�. ADOPebb_ -,'S+a'vw' <br /> R-to ro 3 <br /> CONTRACTOR ADDRESS_ a-A'S1y�uef <br /> SUBCONTRACTOR ADOEss LCJ MONS <br /> TvIE OP•oTHt WEIR: NEW INSTAu4TIOR❑ HOAIVADOTION IQ OIOLTTRUO7ION q <br /> IM 6EVM SYSTEM PFJIARTED F P MJC SEWER II AVAAASLE WITHIN 200 FEET OF SUSDIMJ PRO T6TN7 1 1 NJAV MANY <br /> INSTALLATION WILL SERVE: RESIDENCE 8 COLDAERCIAL❑ OTHER Q <br /> SUMMER OF UNNG LSS7S:—/--MSA►lR W{TD1100MS:�NUIY�EI NSF EMPLOYEES: <br /> CHARACTER OF SOL TD A DEPTH Of 31 FlfT: / aN3'✓`> PITISUSN'SOL CHARMCTDL E <br /> / WATER TAKDfPTH���T <br /> S8rnC TANRUOIWE TRAP RTYPEA*'fr'�Qto,��CA►MRY_�/6Q� _ _No.COMPNR S <br /> PKV 716ATUMN'T PLANT❑aHITARICS YO WAF&IT: wE1LFOUNOATN)H y PROPERTY L11E_j�� <br /> LMT STATION❑ =A TYPE CF PUMP\ BAUD OLEP�•r MTOR ENCLOSED SV <br /> LEACNSNO LINE �NO.S LENOY"OF UNES—�) lfYO'T( Yo TO NEARBTi _ ATFDN��_PIDPDRY L1lE <br /> ALTO MID WIDTH LENOTHI DEPTH PBm11L:E TO NEAREST: 10ATLDN PROPERTY LEA <br /> M UAXWID Q�H WIOTH tXNGTx_T�OEPTN DISTANCE TO N ANN:WELL PDUFDATM PROFt7RY LAR <br /> SmDS AFITS L OE/TWISE _WX SER OIITANC!TO NEAREST'WILL AXI DAYMP POPERY LSE <br /> SUFAM OWmTN LUMTH OFPFN DRSTANCE TO WAREIM WDA._PO%MTMNFROFllI"LINK <br /> DISPOSAL FOLDS 13 WIDTH LENgTH .DEPTH DISTANCE TO NEAREST:IML1__POU/DATON PFIOPERTY UNE <br /> 1 HERESY CERTIFY Y THAT 1 NAVE PREPARED TNS AMKATION AND THAI THE WORK WILL BE DONE IN ACCORDANCE WITH!AN JOAOUM COUNTY OROSLAMCIB AND STATE LAWS,AND PAAEI <br /> AND/EOVLATONSOFT/ESAMJOAOLIIMCOINNTY.HOW OWNER ORLICD`MEO ADEW'I IIONATIME CERTIFIES TIME FOiLDtMA:'NCO F'YTMAT INTHEM ONMAICE OF TRE WOW"WRKPR <br /> TNS PERSIST M M UED.1 SHALL NOT"ROY ANY FRION M SUCH A MAHR"AS TO IECOME MJECT TO WOWNIApeD COWS/MATON UWVS OF C/IFORSA'CONTRACTOR'S HIPNIO OR I <br /> WBCW <br /> ORACIYg BWIE NINATCS/RFES THE FOLLOWING:I CERTWY THAI LA THE PEFDIIAAHCE OF TIRE W tW FDA WHICH THIS Fe"T M MIUCD,1 MALL H7AFUER <br /> .OY PERSONS SURECT TO <br /> WORKMAN'{tOM1FElIA LAWS OF CAUFO A.' THE APEICANT IAIET CALL ES HOW M AE/VANCE FOR AIR.WORM MtlSITHONS.COMPLETE DRAPMD MLOW. p Q <br /> V 1-t <br /> LIONEDX ��L^_ 7TTll:� DATE' <br /> PLOT FINN DRAW TO SCALE)ELME u V <br /> I.NAMES OF IflEM OR ROADS NEMER TO OR IWP <br /> NPNO THE WDRTY. 1,LOCATION OF HOUSE SDNASE DMR P <br /> FOLW IVSTDA OOM{ED -f` <br /> INE <br /> 2.OUTLOF THE PROPERTY.WITH OIIENIIOHI AND NORTH DSECiIOH. EXPANSION Of SEWAGE OWDLAL SYITEMI. <br /> 0.O/MEIIEONEG OVTtARS AND LOCATION OF ALL EIOSTWO AND F OMMO STRUMUIES, E.LOCATION OF WELLS WITHIN RPZM OF ONE HUNDRED FIFTY FT.ON <br /> ARCLNOMS COVOM NEAR SUCH AS PAT"pNlWAYIL AND WAMRLI. THE PROPEESY OR ADAS"POFH(Y. Yr <br /> _........i �" - ..... ...... .............. <br /> ....e...�.'JyKC <br /> .. ...... <br /> ............. <br /> ..... .... . ...... <br /> ... .. <br /> . .......... <br /> ............. ................ ............ <br /> .. <br /> ......... ..........�Y..:..... ... .. .N...... .........y.... ... s ....... .....- <br /> ........ ....... <br /> ...:............:.....:.. <br /> ... <br /> ...... ......... ...... <br /> ........ .. <br /> ........ <br /> ......................... . ...... <br /> :A yAA xx <br /> ......... <br /> �"��.lam......... ..... <br /> a• <br /> ... a ...... <br /> w... <br /> ... <br /> RltrEl -.. <br /> ...........:..............._........... ._. ....... <br /> ..... <br /> FOR bEPAMMNT UES ONLY <br /> a� <br /> APPLICATION ACCEPTED OY DATE: M!A' / Q <br /> TANK PrT OR S"WWiCt"ff Y_� ,r DATE / / FINAL MBPtCT10N INY OAT C, -7, <br /> -�'G� y y.J �, I�rFU /'T rL✓ZGt✓ L�6-V JETL.G <br /> AOOFTIONAL lx)A1MD,T8: <br /> J <br /> ACCOU"MO OIIIY: ADI fACJ <br /> P CODE FW IWQ ANOUSR RRAITED DING ASN I RDCEVED■Y DATE IR)For"MISA�R INYOIGtJ <br /> 2- to /(--- !Ca - 5 8d <br /> Pub,HIIIMI SWV.-EnViM 174(3,/96) <br />