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SAN JOAR IN LOCAL HEALTH DISTRICT <br /> 1601 East Hazelton Avenue, P.O. Box 2409 ' <br /> .� Stockton, California 95241a/m& <br /> �B <br /> APPLICATION FOR <br /> DISPOSAL SITE EXEMPTION <br /> and <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE <br /> ( ", ") 4 %^ a-- <br /> NAME OF PROPERTY OWNER ✓- G f I s F-E <br /> ADDRESS *. PHONE <br /> NAME OF OPERATOR C <br /> '/ <br /> <br /> <br /> . NAME OF HAULER f) <br /> ADDRESS �J-o .b g s t o PHONE,-.S-3-7 <br /> A. Provide the following information on a scaled drawing not <br /> less than I" = 600' (Parcel Maps that meet this requirement <br /> are available at- the San Joaquin County Assessor ' s Office) : <br /> 1. Identify the disposal site location, storage and/or <br /> feeding areas and specify the number of acres. <br /> Z. Identify all dwellings, structures, wells, ponds, <br /> lakes, reservoirs, streams, drainage courses, -or` other <br /> waterways within 1000' of the proposed disposal site. <br /> B. Provide the following additional information- <br /> 1 Duration of disposal (dat.f?-s ) . <br /> Turnover time for feeding of waste. ' <br /> Type of disposal site sect..(rity (. fences, gatf:--;, 9-PatUral <br /> boundries) . <br /> 4 , Type of waste to be fed or dumped at the prc:®t:;i:i)s -d site. <br /> ` . Estimate total gl_(dir,tit"IV Lf'' Jard47. C r jr-o-- <br /> per- acre. <br /> �6 r rov ide work plan for apo? i `f i rin WcAc, ! i a', !cif Ps'€ <br /> D F_Vii(._r-.-i.b `." <br /> i 1 t:.er nat.a.vc <br /> ;.i. t.ti=5 tf'fF.{ P,r ,-�•:1 '.If: r Fig t:®i ::e t a i..!r . " f <br /> r 1ts','r' ilr_it1Vf' <br /> t rl L, i.'.i:'+1"id].t- <br /> o <br /> .. <br /> Vc c::t"C_Pr C.CJn t r-c,1 pro( F%C)l.lr"f.:.c <br /> , <br /> 1'-o pr'(:.iv i.(Ac-, t_hi� ,sP_:::P ✓r.-' >.i"P i rnt r;:-, � t.t:?r: -.iPPCI C Jr <br /> latttior i ZPat:. 1.i n frosit t.t"icr ci; i, 1,;agtt.'.r 1 H< i tr Is9 <-tr it t i (,r- tr; <br /> t:Fie• tat_unp:irn:� i;f any waste or. t.h'ic, j.-ir-1-jjiP1` t",/ - <br /> Signature of Property Owner `aiC�(iatt_tr' (if tlper <tcAr <br /> Date Date ® / <br /> Application fee of $140.00 due per site, per vear. <br /> Application accepted with fee by _ .� ii,,t.e <br />