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t � <br /> EC E I V E® SAE!JOAODIN CODHTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAY 2 71997 P.O.BOX 3W W4 EAST VVEM Avg S DCKoK CA 9M,4M <br /> Rom <br /> ENVIRONMENTAL HEALTH p 54amm you Paw <br /> f APILK7LTlptt q IIEIC� IIDAOC I V'Tf�&. JDA01f7M COUNTY FOR A POOH=TO CONS1ti=AND=WWALL THE VKm .T=AFFLIC/1TTON IZ MADE IN COMFLIMLCE wTTH OM1 <br /> JOAOUOA COUNTY DEVELDPm Ewr TTILE,cNArm 0-1115.3 AnNO TNd LIrANDArm OP amjoAatm COUNTY Pun=HEALTH CSLVICm L#IVCADPCuGITAL mALm p1V=m. <br /> -mADOI$RSAR ATNF 222-N, ` �Y GtllLn / 9� 100—?--n «rY s-k'o cIL7FrT1... FARM-=Ap a24C1 Zl 3L4 2 <br /> owNarenArL£ on l -N S2��Inti�+�� Ca^i A� Ano�ae�R'7"1 VQ�ILunaw� L T��,w�n.1 sNOtra, 3 <br /> owm-crow �•�er e c.e G?T-►l l i AD01l68 9�_l�0, e� sf;.t p� Lsct �s'io <br /> Slit C0WTllACrOR ADORI:sy ura rNofa F <br /> TYFE of waLwLalo: )KPMW WELL O tWrL*cWFNr W131• IOON CM,4o WCL I O oTIaR <br /> O myAuATmu O WELL arerw mom O clw=4ow=r rmvm O vAmn vapAerm wELL• ✓ <br /> O Now O Flrxr H.P. DE►t11 nw exr FT. FOW WATM ova-- - d - <br /> RYFE OF PU MM <br /> O ovroFaElReeE WELL O Awmw cAL weL. <br /> O DEfTRUCTIOM <br /> O alOIRTTIEAL O 0PE1T Foran UQIL OF L,lar ExGLVATT01!_ P/� DTA.of CoROUCTQT CA= 2 1 NCL O <br /> O oouw em msTavm O miAvm PNCSCMMQ _ TY*OF CApNO/O MA-4C IR\1 C_ DW of WELL CACA'S -1 IM 1 O <br /> O rumemoicPAL O wvvm Do"OF etwur DEAL E4.G.�• r „ml1 • R <br /> O MMATUMAD � O W[3o-n= � � Qf*W CM TAul°D ELY_Gret��%'Or,11 i ti GROW cv.4m WJYCf f <br /> r OROcm q,MFm O v. op; —T CONCrMW F>�TAL OY O=Lm O vw Ow d <br /> x DOKN y� L-. Grow LACIONS c ESM CO%AITOVE FIFE s <br /> R98TIfa0: M110 VOTARY AIR 11oTARY AUM_)L_CAM OTKM 6 Cbor YYKO, <br /> lAic.11 <br /> 1"MW CERMY THAT 1 HAVE PRVYWW THO AFPCICATWN AND THAT THt VMW WILL bE DONE W ACCCOIW E WRH SAM 10 ROW COUNTY OPCOMAHM,OTATE LAWO.AND RULES AND <br /> FS+SIAATIOW OF THE 01111 pAcwunmxwv. NOW OWHIII OR UeEN=AaWM$MNAWFA CERTW=THE FOUDYA W-1 CERTIFY THAT 01 THE IMOPWAMM OF THE VMM FOR WHICH <br /> THIS PEFMRR M RRi1 NOf E1YM'LOY PEAtOMi 5110.IIEt;'r'r TO 1MOA7aMW't COMPBffATMlN LAYVO OF C/MJiT]FS1111' CDMRRAC70R'S HROIIO OR SlRi•COMp1AeTp1S COf1ATLFIE CBfrIflES <br /> THE 1 THAT 1 IWMI F TME WORX FOR WMCLI 11at PE1SRIr M lan1EO,1 a1MLL EIwPtAtr FIROONO S'ULt10CT To Taro�aAua coa>�+�attDa Uyyp OF <br /> 7T06 CALL!t lStf FOR ALL t:.'Ot14tlA pWFSCT10M0 AT tsobl stsJwsa. COMSLLTE xlAwdea AT u7iMdt A1"a...A FFrD11fDED. //q <br /> PLAT FLAN IDaw to o w1 Oerr •t. <br /> t. NAMES OF OTIIEETO OR ROADS MFAREar TO OR goUMX O TM PFIO/ERTY. 4. LOCA710H QF HOUSE EEyVAOt b1t:?'OCAI OYCT9A OR PFIOPOtlD <br /> I. OURINE OF THE PFKWMY,@RANO DL ONS AND NOFITN VoMCTW L p1PA1TM 0/SLIWASE DOSA Z D OYGT'ENO. <br /> 7. OOA61 OVR>HFB AND LACATIOFI OP ALL DOLT910 AND FIgF06ED S. LOCATION OF VM=wTT1M RADW*OF ON>:IRMNAD RFrV FT.- <br /> OTImJCTUIIO.RfCt.UDINO COVlFlID AREAS SUCH AS MT1OS.DWYEWAVS.AMO WALKS. ON TIE PFOPERTY OR ADJODW=FROPFRTY. <br /> �. _.._—�._ - -"T — --- <br /> . _ <br /> .::.....:......:.......:......r. ... <br /> 411BACKMAP ...... ......:....................... ..... <br /> .. ... <br /> ...... .............. ..... <br /> h... ...i... <br /> .. .. ..........:.�......L......:...... ; <br /> .......%...... <br /> ...... ...... <br /> ............ ...... ...... .................. ...................................... <br /> DWAR'nwwr USE okLY <br /> ApolttNsn A+wK.d Dy Dat • !1! A. V 7 <br /> DwnelMo w..a11«.bT <br /> ACCOUXIM OMLT: Am► FAG 73 <br /> PE lobs I P6E Mho AMOLAIT BMWTIM O WOWACASH ROCBVRD WY DATE VEMUTME11MCE RO<LUEfr pum= INvolcE <br /> 2g� 1Ltt�J 8``1IXT5•i •9 O/ <br /> Z d W02id Wd l l °6 L66 L—SZ-6 <br />