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APPLICATION FOR LIOUID WASTE PEAMIT <br /> SANJOAMN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOIL 399. 446 N. SAN JOA0111N ST, STOC*T0N, CA 2§201MB# <br /> (208) 409-3420 <br /> NON-AFFUNGAPLE PERNIrT MMIES I YEAR FROM DATI <br /> x0rup1ATS=TF*Nmta} <br /> APPUC ATIOH to HEREEIV MADE TO THE§AN JOAOUIM COLWry Foil A PE AwT TO CDMST RUCT AHDlOR INSTAii T HL 1NUR"DESCR§§ED. THIS APPLICATI&N toMADE INCpAIlIN WI UANCE WITH AM <br /> JOAOLRH COUNTY OEVELOPM(Wr TTTLE,CKA�FFLK D-1110.3 ANO IHE STANDARDS OF SAN JOAQUIN COUNTY FV81JC HEJIITH SERVICE I,EHVOK)NMENTAL 6WALTH DI41910N. <br /> RE,)00 ADOBSOR APNP r{ _a.t I 1� (ZJ- el-e- �` CYTY LOT SIZE 00 <br /> OWNER'S NAAAE AVOK gy 1!•lQNE _ <br /> CON P6kCTOFI ADDKIIS L1C• <br /> >S<AI COPCIRACTDA ADOW W UCA FMWRIE <br /> YYF[of§anc wom, IAEw WiTALU"044 ❑ A0A0UAO01T14h bull tic* ❑ <br /> RHO CFPTIC 6YBTEM FEWMEC IF PULLIC KWEK If AVAKAEil WITTH 200 FU7 OF IIVILDPIG.; PEW Tii7I411 1 NOW MANY <br /> A ■ <br /> INSTALLATION WILL SE31Vi: RjSN ETICE:Ea COMMETSCTAL ❑ OTHER ❑ <br /> NL^"DR of LIVTIIa UNITE- KURJSM OP SADF0C 48: IILwA§EI OF WAFLd)TUB <br /> CHARACTER OF 661L TO A DEPTH OF FEET- PTT!§UILSP COIL CHARACTER• WATVA TABLE DE F7H <br /> SEPTIC TAWRAMAS♦f TRAP 01VFumir-p gp CAPACITY NO.COLAPAPTNIEWS <br /> ►ILO rfttATMFNT FTJLNT❑ DISTANCE TO p[ARSIST: WELL FOUNDATION PFSOSEETTY LAW <br /> UFT STAMN❑ SIZE TYPE OF PUMP SAVO OR IWPAAATOFI RNCLOWD SYSTEM <br /> L[ACH1160 LIKS 1D MO.■11MOTH DF LINES_ _ x tf❑ w DISTANCE TO HEMIKST:WELL ZZ�—O �FouwmTg1—'+'r I PmmwI'Y 1y*--/nf , �) <br /> FAVOR RED ❑WIDTH LENO7H MPTN 016TANCE TO NEAKEET WELL FCWWDAT*N FTIOfEA►YLIM <br /> L4D URDED ❑WIDTH LE HOTK DEPTH tAI IAJICE TO NE&4EiT:WELL FOVHOATLON PRIDPOSFY UW <br /> S"7A¢E MTA E2 DEPTH Y124 MV1A§E15 DISTANCE 7O 1'JEME/T:vrEu)S • FOUNDATION_�1 0 r Pf�P€11T'Y UF4 f P¢ <br /> SULPIF ❑'.MOTH LINGTH DEPTH OkWANCETONEAFEST:WELL—FOLIFIDATION P"OfgTFYLAW <br /> ENSPOEAl PONGII [I worm LLNEETH—DEPTH—OWrANCE TD NEAMIT:WELL FOUNDATION POD PERTY LINE <br /> I W ESY CERTIFYTHAT I HAVE PREPARED TWS APPLICATION AMU THAT THE VMPK VAi W OOHS YI ACCORIOA I!WITH GAN 4OAOUIN COQKrV CFIOWAW-i!AND STATE LAWS,AND EIUUS <br /> AHDKEDULAT0N§OfTW BAN J00LOLRUCOUHT"Y.H¢A#E OY1141[R OIE L]C[N BED AGEHT'SIONAT►lIE CI1111TIFESTIEPOU41A NO:'ICIATEFYTHAT♦H THE PERM AAACE OF YWWORK"WHicm <br /> THIS IEI&M tE ISWJED,I WtALL NOT EMPLOY MY FEAWN IN*!CH A MANN"AS TO WOW 01.40ECT TO WUWJAANY COMPENSATION LAW*Of CAIPDfl14A' COFfTgAGTORt'I"M40 OR <br /> §V§{OWRACIM SIDNAti"CiERTIFIF9 IW FOLLOWINO4 9 CI WWY THAT IN TFIE PEIEOPGAAFFCE OF TK YI1OW FOPS YLi}KCH T7#I KNAR to ID§DED,I @HALL[SAPLDY PElt§ONE SUt11FCT TO <br /> MFKMAN'B COLA 6AT#0H IAWe F C MIA` THE A!KlCANT YUDT cALL i4 HONH wl AOYAEE6R PUII ALL�NMACTTWLR. COEMLM DRAVANG EIEL.Ow <br /> WOMEO x TITL£' C- -s r aTl <br /> PLOT PLAN ttAAw TO 10CALEI§CALF '1s <br /> i. NAAAES OF STREET§OK ROAD§NEAl1EST TO 00 BOVHOW4 THE PT4GF'ETITY, 4. LOCATION OF"OVINE IEwAOE D1400§AL SY6TEIIA DR PHL7P4uD <br /> 7 OL11Lw1E DF THE Prop ITTY,WfTH DIAAFmL%oNA^Ha NORTH DmcTION. EAPAHMN Of SEWAGE 01111POSAL§Y§TEMS <br /> S OSEAENGICNED OVrLM FS AND LOCATION OF ALL EMITTING AM PROPO§EO ITRUMMS. E. LOCATION OF V4L.LS WITHIN KADIIIR Of ONE Nk"gWIEa FIFTY FT Ok <br /> IFICLUOINO COVERED AREAS SUCH AS PATIO$,DRIVEWAYS,AND WALK& THE PPIpPGRY OR ADJOMIG 12010,00 Y- <br /> Iv <br /> t <br /> PAYfMENI <br /> E3Cn�•.Fr� <br /> MAR 2 11997 <br />