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APPLICATION FOR LIDUIO WASTE PERMIT <br /> U SAN JOAQUIN COUNTY PUSUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3.420 <br /> MDM•REFUROAILE PERMIT EXPIRES 1 TEAM FROM DATE ISSUED <br /> ICtmPlWtt If Topfi"t.l <br /> APPUCAT10N IS HERESY MADE TO THE BAH JOAGUM COUNTY FORA PERMIT TO CONSTFMOCT ANO,OR INSTALL THE WOM DEDCRISED.THS APPt1CAInN M MADE M COMP FN WITH IAN <br /> JOAO M COUNTY bFVELOMENT TITLE,CHAPTER 8-1110.3 AHD THE STANOAADS OF SAN JOAOUIN COUNTY PURDC HEALTH SERVICES.ENVIRONMENTAL HEALTH bl"e N. <br /> .FOS ADDRESSOR AP'NI 7099, 2 / IQ� crTY AYJINI.Y3. <br /> ! � LOTf BIZEfaM�. <br /> OWNEA'e NAME AODREBB -� —HES <br /> CDNiIy:,CTORf,( +' 1,h� q � AExME9e �� [y�G "62" L)' UCF O YS F`H1NE 7 <br /> SUB COMiUCTOR ADCNE65 LKI <br /> (y RHONE <br /> TYPE OF RIFT1C WORN- HEW INBTALLATIDN❑ PEPANWAD oN EO DEbTP UCTION❑ <br /> INO CEPTIC IY TEM PUF,KTTEO F"V C SEWER IB AVAI11LE WITHIN 200 FEET OF 8UILDHO.1 PLOIC TFJTNi I 1 HJW MANY <br /> In ACPMwLfon I <br /> SNSTALUnOH WILL tD1VL REp L' <br /> OENE,yyy CA COMMERC NL Q OTHER 11 <br /> OP UVINO V. S; I// FIUMNER OF SEDROOW:­2_NUFARM OF N.4LDYm: <br /> CHARACTER OF BOL TO A DEPTH OFFp]�FEET;_ /SM <br /> P1TUP 6011 CHARACTER: WATER TAKE bEPTN_ <br /> OOF-M TANK/-RX"f TRAP EO TYF*JTA O CAPACITY NO.COMPARTIAEHT6 <br /> PKD TwATMEHT PLAN-IT❑ DMTAHCE TO NEARCOT: WELL FOUNDATION PROPERTY UNE <br /> UR0 <br /> FT <br /> ATION WBRE TYPE OF PUMP J r����S"A�FI�D��OII�L 6FPMATOR IENCL06ED OYSTEM; _ <br /> FUCHNO UNE FQ NO,fLFNGTH OF LINER I- '4V EtFl•+I ITfJNTc-DMTANCE TO NEAFEST•WELL 44 , FOUNDATION 'fir, PROPERTY LRIE <br /> ML SED ❑WIDTH LENGTH_ OEPTH DFBTANCE TO NEAIWSF:WUL F0U?,bATTON PROPERTY LINE <br /> OMPAC& m❑LMDTH LENGTH__OEPTH D*SIANCE TO NEAREfT:WELL FOUNDATION RgPEFOY UNE <br /> fEi9A(iE PRA Vd:riH ?S 1 iTZE 7j6 I HU&MER I DISTANCE TO NEAAF9T:YVELl UC` r:OkMDATION -'J` PF10PEFrrY Ly1E NUC-f- <br /> SUYM ❑YVOM IEh6TH _DEPTHS DMANNCE TO HEA STr WELL _FOUNDATION PnOPERry UNE Q <br /> DISPOSAL PON— ❑WSJTH LFNOTH .DEPTH D(UTANCE TO NEAMM WELL­FOUNDATION PROPERTY UNE <br /> �1 <br /> I HERESY CFRTFY THAT I NAVE PREPARED 7H8 APPUCAT)ON ANO THAT THE WU"'Ma SE DOFE IN ACCORDANCE VAIN FAN JOAOUW CO UHTYORDINANCES AHO STATE LAWW,AND PLIU9 <br /> AND FSVULATIOH8 OPINE SAN JOAMM COUNTY.HOME OWWR OA UCE`NSEO ADEM'S HONATIMF CEN7"S THE FULLOYANO:7 C EPITWY THAT M THE RTW 04-ANC E OF THE WGA(F Dn WHCN <br /> TMD►EMLIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON M OUCH A MAI'tER AS TO SECOME M&MUTTO WOWLIAN't COMPENSAi ION LAWS OF CALDOROA.'CONTRACTOR'S HIMHO OA <br /> SUS-COHTRACTINO BVNATUPE CERTIFIES THE POLIDWINO:'1 CERTIFY THAI M THE PERFT F ANCE OF THE YJOR(FM WM CH TMS PEM"T IS ISSUED,I B1/AL1 FAAPLOY PERSONS 6U1fJECT TO l / <br /> WO AH'S COO�MPEN'SATION LAWS OF CADFORMA' THE AMhi/CAM MUTT CALL 21 HOURS M ADVANCE FOR ALE.REOL.WRI D INSPLOTIONS.COMPLETE t l-i FMq OY PER C. <br /> / c((� <br /> SIONED x M1E:_��_�rnr GATE' 4 <br /> PLOT PLAN SJRAW TO SCALE{SCALE <br /> 1.NAMES OF STFIEETS OR ROADS NEAFEETT TO LOA OOVI VINO THE PROMPITY. -re4.LOCATION OF HOUSE SEWAGE DMPOBAL SYSTEM OR FRpPOBEp <br /> IJ <br /> 2. DITTLC OF THE PROPERTY,WFTH DIIHENSIONO AND NORTH DIRECTION. EKPANIHON OF SCWAOE DISPOSAL eYSTEiA S. <br /> G.OKACNt10NED OUTLINES AND LOCATION OF ALL MOT"AND PROPOSED STRUCTUFEC, 6,LOCATION OP WELLA WTTFNIN M UB OFONE HUNU PITY FT.ON <br /> MCLUDINO MVEFM AREA8 BUCH A8 PATIOS,CHIVEWAYS.AIA WALKS. THE PROPERTY OR AdpMINO PIWOF[RTY. <br /> r <br /> .....................'. .....: .,....o........ <br /> ....._:...: ... - .. <br /> :. <br /> :. ..... <br /> :.... .. .. .:. .; <br /> r��.. '..... , <br /> sf b <br /> ..PUFSLIG.HE?d . ti ' <br /> ;..... .. <br /> . . ... ..GNVIfi�N!DENTAL NE.BTN P��... .. �... . . _ <br /> Q.. : Q (... ... <br /> .......>..... .. ... .......... <br /> FOR OWPARTM04T Ute ONLY yyyTTT <br /> R <br /> APPLICATION ACCEPTED BY GATE: '.r AREA: <br /> TANK. F OR SUMP INSFF,;TIO1N BY DATE J 1 FINAL INSPECTION BY fJ L../ (,�./,'/b'�'L/ OATE��/e <br /> ADDITIONAL COMFNEW S: <br /> ACCOVHTIM'i ONLY: AIOr FACY D <br /> PE CODE FEE INFO AMOVRT ELFISH TER CIMC K16.'H W/IECEP ED ST PATE E/L/PEF"T NLFNMR INVOICE/ II <br /> 1 <br /> Pub.Health Sew.-ErMro.174(aM6) <br />