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IAN J OAULtCAL HEALTH b 15tp" <br /> ibni East @ i tbh Avenu@ 4 P.ti, Oota 20CI <br /> . Stbc�;ttlhy `CalifbFfli� �b2bi <br /> APPLfCATfON pap <br /> bfSPOSAL 517E EXEMPTION <br /> and <br /> EEM NO OP POOb PNOCESSINO ANb PAMING WASTE <br /> t <br /> AM Op' MbMATY OWNER + <br /> AbbpESS01 ' } S�bl 10,5PHaNE <br /> r <br /> NAME Or OPERATOR <br /> AabpEss LR laq Ija Alt- (A4 b PHONE '55 baav <br /> NAME OF HAUUM---____:�-_ <br /> ApDREss . PHONE <br /> A. Provide the fbiibwiMg ihfbrmatibh bh A suited drawing hot <br /> lana thAh 1" a bran' (PArt@1 Mapa that M*@t phi§ requirement <br /> are available at the yah .ibaquih County Assessor' S afficg) s <br /> I& IdOhtify the digpbtai Gita location, atbrage and/or <br /> feeding areae and tp@tify the number of acres. <br /> 2. Id*htify all dwellings# atruttur@§, w@iis# pond%, <br /> iakeaf r@§@rvoira atreaNtey draihag@ tourset' be other <br /> waterways within 1000' bf the pebpbs@d diapboAl site. <br /> B. Provide the fdllbwing additibnal ihfbrmatibh! <br /> 1 , buratibh bf dilzpbtai (date§) A <br /> 2 Turnover tins► fdr feeding bf wast@. <br /> 3. Type of ditpbtaf cite aeturity (fehtesi gat@%® natural <br /> boundri@a' . <br /> 4 Type df watt@ td be fed be dumped at the prbposed site. <br /> 5. Estimate total quantity ih yards or tomo per day and <br /> per acre• <br /> b. Provide work plan fdr appfying watt@ tb iand. <br /> 7. b@tcwibe All tbhtingehty pith§ fbe selecting <br /> Alt@rhA UV@ §itea Ahd PedVid@ the ibcatibn of all <br /> alterhativ@ sit@@ §hbuld weather tbaditiohs warrant <br /> thin tbaditibh® <br /> S. V@ttor tdntrdi prbtddur@a fbr atbrage bf wast@. <br /> I agree tb provide the AbbV@ infbeMA tibh and reteive <br /> author-12atibh frOMi the Sah doaquih LdCal H@Alth bistritt prior to <br /> the dumping of any wast@ bh thit propert <br /> Sighatur@ bf PP`bp@t-ty CWhOr pighatu csf Operator <br /> Date- bate <br /> Applitatioh f@e of 0140.00 due per titer per year. <br /> ApPlication accepted with fee by bate <br /> ev s/tag <br />