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` <br /> , <br /> � <br /> 5ANJOAQUIM COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 186oE.HAZELTONAVENUE'nTOG/,TOPicAy62m'(209)46e420 <br /> Nnm'PEpuNDAoLEF {I4LL <br /> jorADDRi;ss A/ CITY/ZIP � <br /> CONTRAC TOP <br /> PHONE 9,10�1�f <br /> ex � <br /> vvATEnr^n-sosprx: n GEOGRAPHICAL INFORMATION: Cvomma�x x Y <br /> -"s*��'Bsr--------'----- | <br /> Fb'UII----------ji--F-sP�JM-D-DITION-----------'TT--EN-- ' <br /> qsp�L«csMeprp _nvr-Ox-3snv/osscrrICSYSTEM <br /> __ _nsornoonow ________________ <br /> ne <br /> ' <br /> /wSTA LLxT|oww|��;��Vs� � RESIDENCE. - OTHER_ <br /> _ Numnccor-uvwoUNITS: NUMBER or.BEDROOMS: NIJIVISCIR OF EMPLOYEES: <br /> sEPTICTxmx TnnrffiV(-, owwmr, gu| 40FCOMPARTMENTS <br /> rj onsAoETnxp TvpeMo sCw`x'Jnv ____________ 9ai OF COMPARTMENTS <br /> , <br /> o/orxwcsrowsxnsnr n rw/po^nnw n PROPERTY LINE n <br /> 174 urTsrxT/ow SIZE rvpsop0 pxorxpLxw� m oxmoo/�nsp�n�Ton<smo�ovsou,ors�} <br /> ` <br /> LsooKumEn / / LeAo*wnoHAMosxn xvpuwsnLEwGTHOFLINES n <br /> DISTANCE romcmRsor ft pnuwu^rmw_ pnopseT,uwc___ o <br /> ID,, nI'rsnoso »x/orxn Lswor* u ospnH n <br /> DISTANCE:rowcxRsor we/.I-_________ ftm <br /> rouwnmrwV u <br /> ppopsnr, *sK <br /> UT, MOUNDED m/mrx : LswunxA Dspr* M <br /> murxwcsno@sxnsor lfxfsu_ n FOUNDATION fl.. pnopsnr,uxc n <br /> mumpa vvmmu^ Lswsrxu ospn'/ --PAYMENT n <br /> DISTANCE roNEAREST wsLLIt FOUNDATION ft pnopsnT,uws n <br /> [7) DISPOSAL PONDS w'/nzxV Lsw';-,xA ospr* It <br /> omr«wosrowsxneaT wr-,u_ n pnowo^now _ o PROPERTY LINE_~�U1.3 - n <br /> Q SEEPxsEp|Ts momncn______________ vvmrv ___V osprx R <br /> omrxwosrowexnsu` *e/� n p.`L/w"^now |/ pnopsnr,//ws-ENVRGNMENTAL <br /> /HEREBY CERTIFY rHmr/HAVE PREPARED THIS APPLICATION AND THE WORK WILL acDONE|mA000noxmcsWITH SAN.mxouwcoumr,n&n�xmp ' <br /> STATE LAWS AND RULES AND REGULATIONS)opSAN JoAoow/COUNTY. <br /> TITLE. DATE <br /> � <br /> Charactrr 0,1 Soil to Depth )f:" P, /Surnp Soil ch, <br /> ca!-,i- remitted Sorvice Request 4 <br /> [ --p�-_]-- ,-- <br /> cl <br /> owsITsWASTEWATER rnTmwrSYSTEM psnIAIT <br /> " <br />