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� <br /> q qtr - d>~ Y _ �">< , +•, 4'.rM x - q T;ON FOR PERMIT' _, � 3� �`� ',,,�. •`' <br /> iT' k <br /> . P a <br /> y <br /> f - i^ f• 5 �f r�' {.:.`t F-Y L '. i$ �evp } I al,, 'l.' #• <br /> dAt,�#il°►LTH DISTRICT <br /> � a r"��xk tY � - � az ,•p;. 5 � r :r r ;t 7 <br /> v - r ,Avt..v. C TON, <br /> a <br /> 7 - <br /> � <br /> VX <br /> 76y.sSC:F 4- f iSs ; M `3 .�Fe #.!T�l 5 Pt.b S � A � �. pJ1P' xYC1 4 <br /> r.F '"a d�5y� ck. r 1 k _ s ..-.yr.dr,u�r �iI .+ •.i �PJS.." YX3 L ; <br /> p, A 1• E y{ <br /> w ' 4 <br /> {'ipll�faCtlaf <br /> -TYS <br /> s DftTAi LINE � ir � <br /> �r gg mss;...;F _ �k r� �S' ►�W"r, � G Oul <br /> 9 .'' '3 <br /> .t w <br /> ; -. i Vi ANS,TA Of7i Q„:RFRAJ81. DDITION© TRIY shrMer$a ]. <br /> s,,i;,k ;,.''. r{ w '>-rfy �W. ;r+d +y._' ',�,q. ; w�"r.,• -.� "yP.j'"r1 .� I �i'tr rix-2'N ""�' ° fi `3r '_ 'E ?}; <br /> k installation w eblVel <br /> ' � ; �iMta�of Wing "� Gf.. tl• r , ,.� rr* � �" � J `" <br /> oe.a '0" � + `w s,, -.x�%•a c ;`'�' r . Ii. 3 t a 4c 3 hF '..;parr b- - s <br /> PtfO:` FFa4k M (r ! Meithad f POW b <br /> LEA1Ch IINIGIIVE` 'flo l engdl�pf ry Tatah s ; <br /> FILTER BEDS, 0 _Dim to ",` i € <br /> Sopme PITS Q Depth �> ^.� 77Ja <br /> q SUMPS:_ ©.:.Distance to reareet. Well 'Wooundat w ; <br /> DISPOSAL PONDS 0 <br /> i hsreby certify that 1#ave prepared this application and that the w7xk I be Qorse M accordance with°5�n.hosgtrin county prdiner7cas;state la+iys,and <br /> rules and a0eSr r following: - t � . . ..• :. .... <br /> 7eguiehor7s of the San Joaquin Local Health D7strict. - <br /> Hoane owner:ar licensed s nature certifies the fog :'I that in the Pe7fomor-we of Work fof Which dris:permit is k7sued,l shag not <br /> employ:any person in such♦manner as to beporne subject to workrtan',s" lfwnt pE.CaNfQfra#� �or7tractae'e hi<irrp or.sub-contracting signature <br /> certifies the folowinp;"1 ca�tNy that in the performance of the work for which this permit Is issued,I shell wrOw pers6m iaub t to workman;Compensa- <br /> tion laws of Callfornia," ;~ <br /> ,a <br /> The applicant CaM req r n Com tawwnp on reverse aids <br /> ate. <br /> "MEW USE USE ONLY <br /> Application Accepted by + . Date Area <br /> Pit or'Grout Inspection by Dote Firrsl Irmpection by '_"~— Data <br /> Additional C.omrivent.• <br /> 7 <br /> Q S* 88781 Ll Lodi, 089-ml Manteca W&7104 G1 Trsny- <br /> l AppkwA-Return ON Copia to Environmental Health Pem*/Services 1641 E.Flardton Ave., P.O. Box,20W,Stk.. CA 86241 <br /> PEE AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERM17'N0. <br /> INFO AS } <br /> +l4i7121'i11EV.tJaal ,. ;.' ti:{I;. '�'� 44it'� �'-1'�� r,..'"'' . .✓ �.� �� i��� <br /> EH was .3 <br />