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istalled By ❑ Driller "hump Contractor ❑ Other <br /> Concrete Pedestal ❑Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> 'Submersible❑ Turbine ❑ Other HP ;9�= Pump Set ft Standing Water Level 7 - ft <br /> FY THAT I HAVE PREPARED THIS APPLICATION! AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> -Y ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> kC T IVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AIS IN COMPLIANCE WITH ALL <br /> ENSATION LAWS. <br /> 4 r V'ANCE NOTICE REQUIRFED FOR INSPECNS - PLEASE CALL (209) 953-1 69 <br /> TITLE DATEU� <br /> N 61 <br /> F7� �'• _ ,�_ �-y <br /> T- I <br /> hk--- ------ -- - <br /> DEPARTMENT USE ONLY � <br /> ;cepted By Date Area Employee ID# <br />