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APPLICATION FOR LIQUID WASTE PERMIT 0/700610 <br /> BAN JDAOUiN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 3U,446 Y.BAR,IOAQUIN ST,STOCKTON,CA 41625MV4 <br /> C20%46113420 <br /> mOR-REFUROAKE P"mrT EMM I YEAR FROM DATE W"E6 <br /> K.Sipha:T,4,2--ft) <br /> APFUCATON 18 M9ESM <br /> Y AOE TM <br /> TO E SMI JOADIJST COUNTY FOA A FgNAT TO CO—IRUCT AMOMA SLSTALL THE WO1R OF7CM®.TM►A'w'r ON p KFLE>M COMiiWICi YAfN 9M1 <br /> JOAOUIN COUNTY DEVELO"ACH'T 7MY-CIWTFA 9.7 170.3 AND TIE gr—MRO'OF SAN JOADLEN COUNTY FISSIC HEALTH SERVICES•UN W ROIfENTAI IRALTH DIMYION. <br /> �PF T/iILL oul kI►d�'�Xrr f3c�u�cm <br /> ADTGi4 m a� K� <br /> JOS O/IEM,OH AAN. BA <br /> . <br /> OW <br /> �r�/ i E�f,l TT ALORE9S , �LY� <br /> NER's NAM[ J��wllf� A4 <br /> ADOM" °"1diE <br /> cDNrrACTon �! n •wy �t <br /> K,.CONTRACTOR d 1'z /L//l�r _ ADDFcse <br /> TETE AF..RIc Woft-- NON N.TAJATOS❑ RpAwAOQTON O"TRUCTOi❑ <br /> M SEPTIC SYSTEM FERIARTED V PUSUC OVAUI a AV.VIAOE V6T W MO FEET of SURD.IOJ I@G TYTW 4 I HG'N MAPLE <br /> AIPSIAS.II. <br /> INSTALLATION WLLSrVE 1®OEHCf •••,• D OTWA❑ <br /> N1Sr91 op UIIf10 LSfTY-4—IR—�AFS[DIg�OM/K--a MNASBI OF 9ifATS1: <br /> CHAAACT@U OF SOIL TO A OSTIA OF]/SET: MMUkP SOL CHARACTOI' WATER TARP ..} <br /> SRTIC TANNI01i11,6E TAF ❑TYPERAM_ _ c—ACly-/...s•fu�+.Q'�Fn-COSSVARE►dFE1 `J <br /> P1CA TRS mrhmw MANY❑ DI.TANCE TO NEAREST: WELL FOVNOATIOH ITpPOTTY L'N[ <br /> LIFT STATION❑ SQE TYPE OF PUNT SAND OIL EPAATOR 4EPCLOSED SYSTDII FFWPINry <br /> O16TAF{F To NEAIIEfT:KELL��_FOUNM'T70N, <br /> LACISRO LAW ❑ NO.i IENBTH OF LNS <br /> FITw SL 7q— rOwm-'. _4' d6ANiTOwAmsT:WELL�w/ ���Y A. <br /> mou"I EO ❑WCTI IEINETM OETTN DISTANCE TO NEAREST•WELL FOINDATMN FEOFE7TTY UNE <br /> SSVAOE FITS pETTM 812E NUI.�ER'--�"j—DISTANCE T011EAIlST:WELL PJIROILTON PROIFRTY UNE. <br /> = <br /> SUN 43 WIDTH tENOTH D®TN—V--OWANCE T01l NET:WEU FOUIOATON HOR[TY UFE <br /> OSPOSAL POR" ❑WIOTM LTAIDTM DFPTII DSYANCETONEAMOT:WELL FOUNDATION PIOF41RYU <br /> I HEROY CEMY THAT 1 AVE FREPArD TMS AWLN'ATON A11D MAT THE WOIK WAL SE GONE IN ACCOROAh A WITH tAN JOAOVN COUNTY OIOINANCES AND STATE LAWS,AND hKS <br /> AIS,]RLOUVITIOFISOF THE GAN JOAOUN COUNTY.HOW OIATIFA OR MC MED AOENT'S NRNATILM cERTYRi THEFOLLOWNG:.1CU'fTFYTAT MTHE M—ftSAMCE OFTH!WOAKPOR WWN <br /> THS PERMIT IS ISSUED.I SHALL NOT EIOLOV ANY POUIDN IM 6CICN A A`ANNDL AA 70 SOCOME.WJECT TO WpRNA/Yi COAiEMISA7ION LAWS Of CAI1f01R.A-'CORTRFKTOR'S LIOCT OR <br /> SUStONTRAcjVbG SIOIUTLNR CERTIFIES THE FOUOMNO:'I GENTRY T WT IN THE PFJMONMANCE OF TIE URIRR FOR VM"THS PEPSRT to IMLIED.I N/AL EMPLOY PFTISONS fLI61[CT'TO <br /> WoREMAW&COMPENSATION UWS OF CALIMISIUL'TEE AFILCART-UST CALL> MMM IN ADVANCE FOR/W.Ifd M/MSINCTDIIS. COMPLETE DRAHPNC BELOW <br /> SIGNED S /� TITLE 11� __ NTE' SP '2 <br /> PLOT PLAN IONAW TO WALD SCALE <br /> t.NAME.OF FTPEETS OR ROADS NEAwJ T TO OR SOUIIDNo TIE PROPERTY. 'A.LOCATON OF NODE SEWAGE M <br /> C SPOOL SYSTLM OR PPOFOSED <br /> 1.ouvu"E OF TTUE PRMSRTY.WRH OwAwnoHS AO NIORTTU OR[CTT011 QPIWMON OF GEWADE DISPOSAL MTLSK <br /> O.WMIENSIONED OUTLINES AID LDCATON OF ALL EXISTING AHO PROPOSED ciwICTV RFS, [.LOCATION OFIAE %W MN RN"WO OF ONE 11UIORED FIFTY FT.ON <br /> NGygyq COVET®AREAS FUCH AS MT04 DISYEWAYG.ANA W IWC& TLE p1OPERTV 011 AOJONNO F110PUTTY. .. <br /> .. .... .... . <br /> Com . _ ti . <br /> .yyy U <br /> - .:.... : .....MANY JGAOU%Iv:.ZIual#:....:.. <br /> ..PU8L1C.HEALLy.5ER3ltCES-`• <br /> _..:. <br /> • .-..cNY1RONM'rNSAL NEALTI::'Q1VlStGl'l;. <br /> POET DW-040" <br /> USE ONLY <br /> AREA,, <br /> Ea F DATE: /J <br /> �,��D DATE u II1fPEc•TIDN � r r 9'G <br /> ACMMRAMO DrY: AIRF FAC# <br /> R COOS AMOVlIT IISWITm INICA VID ST OATS M I ARIMSOI INVOICE <br /> 0 9 <br /> SRoDa960 <br />