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1v� L <br />/ APPLICATION FOR LIOUlQ WASTE PERMIT <br />SAN'JOADUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O. BOX 388, 304 EAST WEBER AVEtJM STOCKTOK CA 9+5201388 <br />(201) 4613420 <br />1109:90UNDAIIE PERNIT DMINE2 I YEAR FIUOM DATE 12",10 <br />H'.G.y1NlS In T►40aul <br />^PPMATNH118 WMAMY MADE TO THE SAN JOAOUN COWRY FOR A PEHLPIT TD WNBTWWT ANDJWR WWALL THE WOW MCSRO. THIN APPLICATION N MADE M COMINJANCN WITH BAN <br />.OAOUN COUNTY OEVELOPMENT TITLE, CHAPTER 0.1110.3 AND THE STANDARDS OF VAN "ADM COVINTY PUBLIC HEALTH SIDWES, WVNIONIANI'AL HSALTH OIVIAOH. <br />AN ADOPIEOMR, <br />OWRIER'S NAME <br />EUS CONTRACTOR ADOIESS W,.F <br />LOT SQ.E S <br />lIL <br />TTFS OF VSPRK WOIIR: NEW IHaTALLRTIDII ❑ RIRAVADI IMN J9 OSSTPSPCTRON ❑ <br />NO SEPTIC SYSTEM PEMATTED F PUBLIC WWW t AVAILABLE W ITMIN 200 FEET OF BUALDRD.I PSIS' TBSThi 1 I NOW MANY <br />ASPNa•SFI. / <br />NSTAUA7ION WILL SERYL• RESIDENCE Ai commminAL 13 OTmm ❑ <br />BLM91 OF 1I1R110 ,Nis:NUmIll ON NRROOMS:T / NRMNH OF aSVIOYSSN: <br />CHIAACRR OF SOIL TO A DEPTH OF ] FEET:_ RR/VUMF SM CHAIIACTtft WATER TALE DUML <br />SPHC TANUOlASE TOW ❑ TYPEIMPO_ �~ CAPACITY NO. COMPARTMENTS <br />FRO TPINA7MNRT PLANT 13 OSTAISCE TO NEAREST: WELL FOUNDATION m3weDY LS! <br />LIFT STATION ❑ %R TYPE OF PUMP SSW OIL R►ARATOR IENCIOSED SYSTEMI 1 <br />LSAcM11S LRLN At NO, S LSNSTN OP LRIES FE L OISTANCS TO NEAREST: WEER FOUNDATION �p � PROPE" UNE 30 <br />PILTM SSD ❑ WIDTH LENGTH DET, DISTANCE TO NEAREST- WHA „ FDUNDATK* PROPERTY LJIt� <br />MOU DW ❑ WIDTH +1 LENGTH _ 17EPRN DISTANCE TO WARIEST: WELL — FO WAMI7 PMPNRTY LEPE <br />AVERAGE NTS SI OWTH +s SIDE NUMRPDU--.-F-7 DISTANCE TO MWINT: WELL_—r 1TY FOUNDATION Prim" LINK -IS <br />SUNNM ❑ WIDTH LENWH DEPPII DINTANCE TO IEAIES'1'r WELL_ FOUNDATION PMPRPSTv L)1E-- V <br />INSPOSAL PONOS ❑ LYOTN Lv—N DEPTH ORANGE To NEAELEST: VM.L_ POIRDATvN MIOPQDY Law <br />V HWVY C6RFY THAT I NAVE PREPARED TNS APPLICATION AMC THAT TME WORK WILL R OOHS N ACCa1pANOE WRH SAN JOAOUI I COUNTY ORIDNAFLCES AND STATE LAWS. AND AMES <br />AND TESIRATIONS OF THE SAN JOAOWN COUNTY. BOL! OWNEROR LICENSED AGEFT'S SNNATUFE CCRTNIES TIRE FOLLOYNNS: '1 CERTIFY THAT N TNN PNFOIBAAHM OF Tit WOM POR WMCFI <br />THIS PERMIT IS ISSUED, I $HALL NOT EMPLOY ANY PERSON IN SUCH A MANHO! AN TO BECOME SUSPECT TO WDFILPAAWS COMPENSATION LAWS a CAL poRNNA.• COKTRACTOR'S /too OR <br />SUSKONTRACTINO SIUNATUIE CIATWES THE FOLW WHO: '1 CERTIFY THAT N THE P"FONAµCE OF 711E WOW FOR WHICH THIS PUBIS, M (MOND. I 04AL1 WPLOY PNIINOW SUBJECT TO <br />WORUMWS COMPENSATION TAWS OF CALFONGA.' THE AMMAAANTT -rMMUST'C^ALI 24 HOURS N ADVANCS MJII ALL R[OISUID MNRSCTIDNS. OOMPLETE ORAYNq WOW. <br />SmmD x1' ,� <br />PLOT PLAN IDRAW TO SCALER SCA:E ' RP <br />1. NALIES OF STREETS OR ROADS NEARER UR TO OR BOUNCING, THE VPIDMI' V. 4. LOCATION OF HORWASE DISPOSAL SYSTEM NR PWPONND <br />2. OVTLSE OF THE PROPERTY, WITH OMENINOW AND NORTH DSECMN. I FY —hm as SLWAeF elVftI—I — <br />a. UIMtM-0 W UMA AND LOCATION OF ALL E%STMS AND PROPOSED #TwXmx"Jj t�I% 1 S. LOCATION OP W WI WITHIN RA"m OP OF! HUNDRED q►TY RT. ON <br />G NNCLUOSA COVERED APNEAS KILN As PATIOS. DRIVEWAYS. MIO WALLS. // F s'' THE PROPVRY OR ADJOMD PIIOPOEIY. <br />FOR OBARTMErt RISE ONLY <br />APPLICATION ACCEPf:D % SY p DATE: • b + <br />. <br />PIT OR [USG• NGrccTIDH SYDATE L FOAL ...NW _--- DATE <br />"� IONAL COMMENTS: C�iL�nat..�Q' <br />ACCOUNTING ONLY: A10! FAC/ ^ <br />PE COO[ PEE LIFO AMOUNT Rl3AVttfD C 121 RECBV[p BY DAT[ SMVdC■ <br />/o S SU 041-13 <br />