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s <br /> • <br /> T �IHAwlES I <br /> WPLLeatlo¢ is here yew Sant CCOmpiete y ` "i1 I'cat�E ISSUEp <br /> Joaquin C sada '.° c aequte Cotat <br /> Job Ad ��S CGI r7' 1 m (i a 3 ¢ Tonq�C ty O d 00bat . 49 ,,u in186,� and g`rc'ck herein des<.- <br /> dross <br /> ttlee and Retitti¢tlay, 8b1a <br /> Owners Noma Ct'� I cnv�r <br /> or Atldess <br /> Q Lot Slee/Aereagc <br /> ne <br /> ^^ !! �sl r� � fir it <br /> Contracta /7� ltSul�� 6rD�^o -�cnuP k�it�tln <br /> _ Pho ,,.. <br /> TYPf OG WELL!PUMP Address /� ayP <br /> WELL O RO6¢4t ff� <br /> L :"Se No.50 q,s' <br /> PUMP INSALLAr0N WELL REPLACEMENT Q CESTA Phone '7 - <br /> DISTANC£ �T, SEPTIC TANK SYSTEM REPAIR ❑ UCTION Q qtt <br /> of Sefrv��ice <br /> f0UNOA ON —� SEWER LINES OTHf:R s r q J C <br /> AGRI -��-� DISPOSAL PLD. PROP.501- Z9�; OA 41.1 ❑ <br /> INTENDED USE OULTVflE'NELL OTMER WELL <br /> TYPE OF WELL PflOf3 r "ITS/SUMPS <br /> C Indyylrial C� —�"M'4�� �N$TRUCTtON SPFC1fICAT10N$ �' <br /> O Mantq Die. of Wei Exovation <br /> ('.l Oornesdc/Prvate ❑ Graw Pea' C Tracy Dia, of W <br /> I'I P¢Wc n Olne 7 ype of Gai p ek Cnainq <br /> (' Deaa Depth of —�— SOlt]ticydp� <br /> I I Inigatipn _acpc.. OePN I , 1,a, Grout Seal <br /> Sunaca Sed InsaalNo i. Type d Grout c't�� <br /> Repair Work :m U Type :: '..rip �J � <br /> Wei Oesfruc:Icr O Wel _- � r �� State work Done <br /> 3-14ag iraterlal a D Pth <br /> Depth " •; - . S PS1Ler raw->al t aapry C2m�nt S/arrr r7f <br /> TYPE OF SEF!IC. .YORK: rwv NtIALLATIDN RF?AIR;ADDITION I I �er <br /> DESTRUCTION I I 'No �plip system ' <br /> permnled if public &twat is <br /> IrtaiasaUOn we a+Ye: R6sdetiz Canrmercielaw�Nde wirnin 2D0 leer-! <br /> Other <br /> Numbm or Gvrq rmiq:_ camber at badnaoms <br /> CharaUar of edit M e depth of 3 lel: � <br /> SEFTX 7A.-JK ❑ Tv>ullfg yWtar table d oM <br /> CaWtdry <br /> PKG. 'AF.1'MENT PLT.❑ NO. ^- nt+ente <br /> Madrid a( Disposal <br /> Ois7'ce to wear. Wdl Foundation <br /> Property Una <br /> LEACM14G UNE Q No I L*rQllines ToW length/size <br /> FILTu4 MED O D=wce a weat: Wail F'oundeoon Progeny Line r <br /> St-, AGE PITS =Ret Sim Numhar <br /> sumps Dw Gc k"emst: Wail Foundation Property Una <br /> DISP-_SAL PONOS = <br /> I hereny canlfy that I have p+e"_rJd NIt IJG"Oon end that the �k wilt be done in acxordanae v/ith San JOaouk+¢agnly ordinances, stat,laws, and <br /> ,W and regulations of the =.a^Joegtir :.—ty <br /> Home ownM or,licetued spa= I uineltn ahTroa the folVmN: -1 oenify than in the Deffcrmence of dte work 1a wftich Nis Derma 4 isaued, I shad not <br /> etncfoy any pefean M sup' -a:-9 is taxYsme subject to wohman's compensation taws at California." Contractors hiorq pr suo-ocnoraczng sgnature <br /> cert.is the following: 'I :Yf in, J 10hTerMe of the work for which this pahrk:a issued,I shall employ persons tufect to x•Jrttran'a mmpansa- <br /> tion lave at California." <br /> The eppld f/tr r���c,(y�na�d��na. Compete da.g ide- <br /> sigMa Tde: Pra�erT+ttyfPr- Date; S qS <br /> FOR DEPARTMENT USE ONLY <br /> A006Mlnn Accacasa k Data Area <br /> Ph of GlmN Inepe.»r of �— Cate Final Inspection by Oats <br /> ADa�ai :s��rw; <br /> all t+ ro. Sen Joaquin Co¢nty Pebllo +Icaltb Scniccs <br /> environ 4tr1 Heal" verAitlsenloes <br /> 445 N San Joaquin, P O Box 2009, Stka. GA 95:01 <br /> Fel AMOUNT AMOUNT REMITTED CUH a(0E1YEg aY DATE PERMIT NO. <br /> IN <br />