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APPLICATIOIf FOR LIQUID WASTE PERMIT <br />SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 <br />IIOt4kEwMZIP PER LL EXPIRE? 1 IEIIR FROM pifTE ISSUED <br />tompMt! IR Trouts) <br />APPLICATION P HEREBY MADE TO THE BAN JOAGUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOXIA INSTALL THE WORK DESCRIBED, THIS APPLICATION If MADE M COMPLIANCE WITH SAN <br />JOAGUN COUNTY DEVELOPMENT TITLE CHAPTER Sul 11093 AND THE STANDARDS OF BAN JOAOOIN COUNTY Pusm HEALTH BEMC£e, ENVIROHLEMAL HEALTH DIVISION. <br />JOB ADDRES6109 ApooddepeOppeN G? 11 r e Q r. CITY (•-^ 1 �-vSiR CR LOT mu l!� <br />OWNER'S NAME •MAe <br />INNI Yli I�GJ-� CI Cv}.-. __ ADDIIE38 3 Cluj PHONE <br />DONIRILCTOR l •' 1yL V7y ILC/- ADDRESS 0'0 ES oZ 6 5-o IXC/ % g ss`y PHONE@NP:??de?-7`?dIZ <br />TYPE Of S$PTIC WORK; NEW INSTALLATION P'•� REPAOVADDFTRON IN 0E rImm:TIOH ❑ <br />No SEPTIC SYSTEM FEFrANI ED IF PUBLIC- SEWER IS AVAILABLE WREN 200 FEET OF BUILDING.] PELC TE"Jol l 1 HOW NLMY <br />,�,/ AppBaslPn J <br />INSTALLATION WILL SINE: RESIOkTME IO COMRERC1Al ❑ OTHER ❑ <br />NUMBER OF WINO UNITS, NLRAIM OP lmROOUB: R NUMBER OF EMPLOYEES: <br />CFIARACTER OF GOIL I A DEPTH OF 3 FiEE% Fi�Ikr�� N1 PITIBUMP BOON CHARACTER: C 4�C1 • WATER TABLE DEPTH •� <br />SATO TANAXAWSE TRAP C� I *wwRfO P • -1 CAPACITY 1co NO. COMPARM&NIN nE <br />MCO TRFAWAVIT PLANT ❑ DISTANCE TO NEARNIT: vvELL �S�A FOUNDATION III PROPERTY UNE„j 7 S <br />UFT STATION E3 w TYPE OF TAIMP SAND DR. SEPARATOR ENCLOSED $YSTEMI _ y <br />IEACNNO UNE RO No- a LENGTH OF LINES .� deleteL) • DISTANCE TO NEA/EBT: WE L L S` fll P'OLMOATION�y� PROPERTYU! 7NE 1 <br />FATDISFD 13 WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION PROPERTY UNE <br />MOUNOW ❑WIDTH. I� LENGTH 1l DEPTH DISTANCE TO NFAJEBr: WELL FOUNDATION PROPERTY UNE <br />!®ADE SITE E�CfEPH1 .F� r ORE �i II H MSEHIONNOqeOppeepeeppe DISTANCE TO NEAREST: WELL FOtNDATON 5'. • PfflPc RY UNE <br />!Lupo ❑WIDTH LENGTH _DEPTH DISTANCE To NEAREBT: WELL.. FOUNDATION PROPERTY LINE <br />Otg07AL PONDS ❑ WIDTH LENGTH DEPTH DISTANCE TO NEAREST: WELL FOINNDATION PROPERTY LINE <br />I <br />HEREBY CERTIFY THAT 1 HAVE PPEPARED THIS APPLICAT10f1 AND THAT THE WOFI( WALL BE DONE IN ACCORDANCE WITH PAN JOAOUR! COUNTY ORDINANCES AND STATE LAWIledded <br />ANO IMES <br />AND fEGUUTMNS OF THE BAH JOAOIIIN COUNTY• HOME ONMFIi OR LICENeED AOERTS OIONATIRE CERTiIEB RHE POLLONi1HG: T CEiSTIFYTHA7INTNF PEIi'OFEMAJIOE OFTHE WORK FORWMRJ1 <br />THAN PERMIT is 1lmwm I MALL NOT EMPLOY ANY PERSON M SUCH A MJLWR A8 TO BECOME SUBJECT M WOIRMAN•S COMPENSATION UWS OF CAl1OIWA.' CONTRACTOR'S HOtRA OR <br />SUE -CONTRACTING SICWATUfE CERTIFIES THE FOLLOWING: T CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOP. WHICH THIS PERMIT 13IMIED. 1 $HALL EMPLOY PERSONS SUBJECT TO <br />WOFECMAN•S COMPENSATIO'" LAWS OF CALFOIININ THE APPLICANT MUST CALL 24 HOW W ADVANCE FOR ALL 0UHI RAE"D INSSPLIJ:TIONS. COMIP ETE DRAWING BELOW. <br />BE OW. <br />SAHEOX A/i N RRL.E.6 >—T �+c�TOf OATS: depend> <br />PLOT PLAN IDMW TO BCALLT eCAIE _ 11 to <br />I. NAMES OF STREETS DA ROADS NEAREST TO OR BOUImO'Ntt THE P110PEPlTV. S. LOCATION OF HOUSE SEWAGE OIJa'OBAG SYSTEM <br />OR PROPOSED <br />2. 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E......s.. <br />e� : <br />i1-... :»....o... 1111._ "1 11 — — 1111 <br />1111r <br />1111:�SAW <br />1111.. .1........ ... IN I <br />....:......:.....: � 1111:. _ <br />....°......_...e���.��:::.:��.:.:.::.::Nib0 <br />--:::::�.- _... <br />«.......... ».....:... a . <br />..........:...... <br />........b.... Gio1,411• 1*004490904+ <br />a......�..... 11.11. <br />... .. .......:.. ,......_....._..:. _1111..._ _:1. <br />°1111 M.... . <br />QWON Olt III al <br />Pub. Health Sen. - ETMro <br />aaF2.,L- <br />r...RWAM <br />OR <br />0 i 1 <br />. 174 (31967 <br />