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SEPTIC TANK/OREASE TMP ❑TYPE M / CAPACITY / NO.COMPARTMENTS <br /> WO TREATMENT PUNY❑ DIST TO NEAREST: WELL FO TION PROPERTY LINE <br /> UFT STATION❑ ME TYPE OF RIMP SAND OIL SEPARATOR(ENCLOSED SYSTEM( <br /> LEACHING ONE ❑ NO.6 LENGTH OF LINES DISTANCE TO NEAREST:WELL FOUNDATION PROPER( <br /> FILTER SED ❑WIOTN LENGTH DEPTH DISTANCE TO NEAREST:WELL FOUNDATION RIOPERI <br /> MOUNDED ❑WIDTH LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNOATON PROPER( <br /> SEEPAGE RTS ❑DEPTH ME NUMBER DISTANCE TO NEAREST:WELL FOUNDATION PROPER( <br /> _ SUMPSLyL-�y�I�WIDTH_FL LENGTH"?nY DEPTH DISTANCE TO NEAREST:WELL�Q r`r FOUNDATION,"Q ( PROPERT <br /> DISPOSAL PONDS Ll WIDTN LENGTH DEPTH DISTANCE TO NEAREST:WELLFOUNDATION PROPERT <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES AND B <br /> _ AND REGULATIONS OF THE SAN"AMIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWINO:'I CEROFYTHAT INTHEPEPIORMANCE( <br /> THIS PERMIT IB ISSUED,1 SHALL HOT EMPLOY ANY PERSON M SUCH A MANNER AS TO BECOME SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' C( <br /> SUBCONTRACTING S INATUR E CERTIFIES THE FOLLOWING: 'I CERrIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 BHALL EMPLO <br /> WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 34 HOURS IN ADVANCE FOR ANLL+RMURm INSPECTIONS. COMPLETE DRAWINO B <br /> SIGNED X 42 2 TITIF: ! i DATE: l <br /> ROT PUN(DRAW TO SCALEI SCALE 'to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL BY: <br /> 2. OUTLINE OF THE PROPERTY.WITH DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES, S. LOCATION OF WELLS WITHIN RADIUS OF ONE <br /> INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. THE PROPERTY OR ADJOINING PROPERTY. <br /> ! '�JUy4 <br /> ,Ir LckS N%ku. �.tl T/o <br /> �V <br /> _.. .__ .$Ary JOAQUINI <br /> ..... PWBLIC HEALTH: <br /> . - -- - - <br /> ENVIRONMENTAL HE, <br /> FOR DCE�PARR MEENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE: ` ARE <br /> TANK,PTT OR SUMP INSPECTIO14 BY p U DATE / / FINAL INSPECTION By DA <br /> ADDITIONAL COMMENTS: IZ�2)�jg 3/R�y-(I J, CPOIJC0AIA131C TO&O <br /> a <br /> ACCOUNTING MY: AID/ FAC, <br /> PE CODE FEE INFO AMOUNT REMITTED HEC (CASH Rnsvp BY DATE SR/PERMIT NUMBER INVOICE <br /> Pub.Hearth So".-Enviro.174(3/96) <br />