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<br /> Applicatiofi is Itetal3j�Tilade t8`tfib sfi tfl) #L C 1�f&alth i)IS ilbi for a�Okmif to construct and/or install the work harem de?;cribed, This application is
<br /> mgd ifi�a Tia i i€inth li I {jp1( �f�` ttL P111 6�1 M f rllragij of No. 1862 for well/pumoiand the Rules and Re ulations of the Ssn Jbe uin
<br /> LaCel Health bistrict:M1i + € $ 'rChk+ae Yi = e 3 "9A x g
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<br /> Owner$ Name 1L 'SlC1> ,� °Y = 5' Addres3 '" hone
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<br /> 4 TYPE t]f WELL/Pt�MP`t � < {NEVI/W�LL�O a' ,:1 �,4111rLL I#I LACLAJItNT :0` � tf DESTRUCTION �. i
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<br /> INTENDED P�b[`WLt��hOBLEII+I ApI�A j�"CO�ISTRUCT� N 5'PECIPICATIONS -- V-
<br /> j,Cl InfldtHel w sf3btE6fi fVtaLit;}ba bia bf Lflfell t�toarahotl u Dia. of Weli Casin M.: .
<br /> `L C� omekiicl riv t�%`� ` U`iai�ef f�a k� fraoy 1 f# ypb of G�asing < iS @+f€tati$ns 9},
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<br /> t f'1 Public of Groot Seai Ty of dto:iii f i
<br /> i 1 ltri�arton .d� pf� iptii�' Sufiace Seal inatelled.byJ _
<br /> Repair INorknt]oneT,� i lfUja' A, #} pi Siate Work Done
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<br /> ` TYPE OF SEPPTIC WORK Nf:W,iNSTALlJ11It�N I REPAIR/'ADDITION 1 ) eSDESTRUCsTION 1 11Nd scone system per�rtfitted if public sewer is y. -yi- .L-. a. 54•�a.Yix�r..w _ - a '•u: n -
<br /> " r i i _ x i ?t a vailahblB Within 2M teat l f
<br /> € Installatton�uvill rvliice� oriftr�lir� tuOt tar ; s ;
<br /> '-'a" Che/ ctlse Ot�'t }�Oh ItrF T�" 'S f- t ° ,•.arty q a 4»." -a s=rS r�r JAM WAW table depth - 1
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<br /> a.1 hdiaby t:elllfy 41ifi I 0*0 �� Olraf�#j'rho tYiaf th�w$rlf willllr§d��ie lfi at cbrdat4�i3 vliitti��n Joaquin courtly iitdinances''state laws, and i
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<br /> Hgind tiiivt r b lief: d elftj "$1 111fF I - }�li iin� �"l cerii#y�h�lir thb iperfdrtnititicA bt tNe work fol which fhF5 permit is isstied,'I Shall not
<br /> r �4.i ariip o}i.afij►�al it It f it i s � t nas lit ibr [tdn IaWe o_W1111 rii�i bmractors hiring or 'sub-conikhetmg signature i 1
<br /> certifieffi tlii;f@51f r < '1"t§�ti tli i #R ' ti $� f th`*Wotk fair Nhich thie'fFerrilit is ashued I§haiit eh piny persona sublecl to iivorkrrtan 9 Eompensa-
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<br /> Appifcehi 04 11 A. �lrfrailii f ��Ith �ah�i�f>fSerVteea i F 1
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