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1 <br /> APPLICATION FOR LIOUIO WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)4683420 <br /> NOR•REF RD►BlE PERMIlPIRES 1 YEAR FROM ORTE 19Wf0 <br /> IC mpi1l1 M Trb%mLl <br /> APPLICATION EM HMbY MADE TO THE SAW JOAIIUIM COUNTY FOR A OFIYAE TO CONSTRUCT ANDAOR WSTALL THE V FK DEBEYOSED,T/SS APPLICATION M YALE MIN VANCE N4TN SAN <br /> JOAOUN COUIfVY ORONAENT TTTLE.CHAPTER 9IUOBA ZZ <br /> -1110.3 AND THE STANOS Of N JDAOM COUNTY FVIUC AMY"SERVICES.E7F1/SpNYOITULI HEALTH <br /> DMSgN. <br /> N <br /> ECS cmL 4 CSt� IOT%M <br /> JDs ADpiLES&OR A.°NF )/{�� <br /> oWNER•1 HALVE /S EXl `0" ADMOS S <br /> CONTIIACIOR <br /> ,.��Y'jd lCL.T�ES ADM.. P 1-1 <br /> I NIM CONTRACTOR ADOAESB <br /> UCI RINK <br /> T7PE of SEPTIC Wom. MSW MASTALLATIOM❑ IIPASVAOOITIOX OFATwxIoN❑ <br /> HO SEP,_METEM PEAMRTED IF"aW WINE1111 AVALAEIf YATHIN 200 FEET OF INUU IO-1 FDIC TESTMI f 1 NOW MANY <br /> AP�MR I <br /> NSTALUMN MMU.SEINE FIENOFNCE❑ COMAEICIAL❑ OTHER❑ <br /> mupmFR OF LIVING UNITS! I NU IS OFS S:I—N.A4UR OF MPLOVM: <br /> CHARACTER OF SOIL TO A DEPTH Of 9 FEET:Z Tyr^ WTMWp SM CNARALTER WATER TANI E IV" <br /> urne TANSJORLAN IN" Q rmv%1FO CAPACITY NO.COISPARTMBNS <br /> FNO TREATMENT MAN-IT I3 OISTAMCE TO MSAMT'. WELL FOUNDATION PIa7PFUN <br /> RrY LE <br /> LFT STATION❑ BRE TYPE Of PUMP SAND OIL aEPARATOR IEICLOSEO SYSTEM I <br /> ]�� �_ <br /> ♦ —tVIOPUITY UNE ` <br /> U HIW UNE �NO.•L9lOTn OF ONES I ` � DISTANCE To NEAREST:WElL�C��FouNOATION <br /> MLTlI SFD ❑1YIOT1f tENOTN_ <br /> DEPTH DFITANCE TO NEAREST:WELL FOU!AATID/I Pl PMVPEM LINE <br /> � <br /> MOUNDED yAOTH LOM <br /> m_DN DISTANCE TO NEAIIEST:WELL <br /> FOUNDATION PIIOFEITTY LINE_ <br /> []17EPTH an NUMDER DISTANCE TO TIEARWt WELL FOUNDATION PROPERTY UNE <br /> fEBAAE MTA 'T7 `��FOVNDATON `O PROPERTY lllE "'I Q1 <br /> Stwen la'CVIOTN �LENOTH (i,��OEPTH�_DISTANCE TO NEAREST;WELL f rS <br /> DISPOIAL FOR" D WIDTH LZNOTn DEPTHDISTANCE TO NEAFEST:WELL— <br /> I <br /> PTFDPERTI'tSeE <br /> 1 HEIESY CET<TIFY THAT 1 HAW PRNAAED THIS APPLICATION AND THAT THE WOW 1MLL SE DONE N ACCORDANCE WLTH SAW JOAOARN COUNTY DIONAIICES AIA STATE LAWS,AND RUBS <br /> ANO 1lOO1A71OW Of THE SAN JOAOUIN COUNTY.NOME 0""on UCEIi1ED A0[M'S NSONATIIIECHTTFTEI INC PoLLO'MMO:'I NLATOTHAT OF PETVOI"-'CON7RACTOWS NSSNO OR <br /> THIS KMW IS MSUED,1 SHALL NOT EMPLOY ANY POISON N SUCH A MANIEX AS TO BECOME SUSdE.'T TO WOMCIAALr6 COAKWSA7TON is tm Of l 0 OK*l IG• <br /> SUbCOMRACTTNO MONATUAE CVMMO THE FOUAVAM:'I CERTIFY TRAY IN THE Po"FI LANCE Of THE WOW FOA WHICH N�� E OFAVIREY PERBONS NIO.iCT TO <br /> W oW.MAN•S CONFENSATION LAWN OF C�ALOOISAA.'M APFUCAMT NUST CALL M HOW m ADVANCE FOR ALS RSOLMM —E <br /> SIGNED X � TT-T! TITLE'.�.1��� 1'/`e r .:7L N <br /> MOT PLAN ERAW TO SCAIEI ACALE 1° <br /> 1.NAMES OF STRZTS OR ROAD1 NEATEST TO OA DOURANS THE PRDPMITY, 4.LOCATION OF IN IME SEWSPOAOS ALlYfDISPOSAL SYSTEIi OR 0 Fill ED <br /> 2,01AI1JNE Of THE FIOPORY,wrrH dAEN11toN1 AND <br /> NOMTH DEEcnoFl. E7(PAWSIDN OF STWAOE DISPOSAL Ev>rTEON <br /> �.OUTUWONW ovrtllES ANO LAC LOCATION OF ALL ND"OW AND PROPOAM STIt UCTUREC 6.LOCATION OF WC11D WITHIN RADIU1 OF 011E ihIIOIED FIFTY R.ON <br /> MCWOYq CO%4U4Eg AAXAS SUCH AS PATIOS,DRVEWAYS.AND WAEAS. TNS PFIDPOffV 011 ADJOSOID pFOFE1DY. <br /> ........... <br /> c� <br /> r, .... <br /> ..... . <br /> Lot <br /> ... .......... <br /> .........: . <br /> .. :.. <br /> - . <br /> o . <br /> r R, <br /> AN;... <br /> IN <br /> . ........... ._....... .......... <br /> FOFI DEPAMVENT INK ONLY 5'} �]!{� <br /> pATE:�_ AfA'-�L+�1La:_LS--L <br /> APPUCATgN ACCEPTED By <br /> TAMC.PIT Oft BUMP NSFfCTgN BY?= GATE 1 / FINAL S16PECTION ay DAtC <br /> Qom` <br /> R <br /> �p,� � S .♦ L �� !ST 2E�t <br /> ADDITIONALCOMMBITe: I^��77 -U••'/// '� <br /> TqXaK <br /> u o'4 <br /> ACCOUMMO ONLY: AAP FACS <br /> PS COOK FEE UFO ...IOIM2T RBAITTEO IIEC/fJ AFH NMQ%AT11Y DATE sq t PwaT NURtaEL <br /> IINOIC! <br /> 7 s <br /> 5 KO t $a <br /> I <br /> Put.HSNDI Sere.-EnWC.174(3188) <br />