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----- ----, _-•• .��i .��. ...y5... t�.uay.c:Code). �-Z' vruxp z,Article L, Section 341, Title 8, California Administrative <br /> ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as <br /> noted above,unless such person has a permit to do such work from the division. <br /> ❑Division of Industrial Safety Permit# <br /> I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county <br /> ordinances and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this <br /> county to enter upon the above-mentioned property for inspection purposes. <br /> Date Applicant <br /> EHD 43-02-007 <br /> Water Well Permit Contractor 13mlaraclion 4-02 12/23/2003 <br /> /dyr �lt'V9 v�1 r 1 <br /> L69L-£S6(607)33VJ 39V3'ld-SNOLL3349NI Mod"W"6311 3311ON 3JNVAQV aQOH K w0 1 <br /> 'A.LNOOJ Nlabvor NVs do SN011Y1no3a ONY s310a ONV SM V7 31V1J:'S3JNVNIQao <br /> AJJdnOJ NInaYOf NVS HIIAt 23NVGV033V NI 3N00 38 771M aaOM 3H1 QNV NOLLY311JAY 51111 Q311Ydand 3AYH 11VHJ,Ad1.LM3J A83113H 1 <br /> U 3NIl Ala3dOad b NOLLVONnOd M 113M <br /> U 1s3av3N 013JNY11;IQ <br /> H1d3Q U HIai*k a3awnN Slid 30vd33S <br /> 141� 3NI7 Ala3dOad (♦ NOIltlONn03 U 113M JS3vv3N 013JNVISIQ ❑ <br /> U H1d3Q U <br /> H1DN31 H a+alM SQNOd 3VSOdSIQ ❑ <br /> U 3NIl A1a3dOad U NO]LYUNnOd M 113M U3aV3NO13JNVJJIIQ <br /> U Hid3Q 11 <br /> ll111oN31 U xlelM sawns ❑ <br /> 3Nil Ala3dOad U NOI1VONnOd a 713M Jmuv-AN 013JNYr51Q <br /> � Hld3p d <br /> HLON31 O H101M Q3QNnoty ❑ <br /> U 3NI7ALa3doad U NOl1tlONnod <br /> U M 713M MVV3NO133NV1SIQ <br /> HJd3Q U <br /> U 3NI7 A1a3H1ON3'I U 1nQ38 113171[d31'lld ❑ <br /> dOad M NOILVONn0d M 713M lsdav3N 013JNVisiJSIQ <br /> U S3N13 do HLDNa-1 M1110# <br /> Sa38WVH3 ONIH3V37 ❑ 93N13 HJY33 ❑ <br /> (W3JSA9Q3S01JN3)HO1VMVd3S 310(INVS ❑ dWnddp3JA1 3215 NOI1v1sJil3 <br /> a 3Ni"1 A1113dOad ❑ <br /> .T 11 NOIIVONOOd 11 713M :JS3aV3N OL 3JNYJSIQ 1NV7d Xl'J71d ❑ <br /> SLN3N""WO3 JO# Its AlIJVdVJ <br /> OdwrdaAL ara13sv3aa ❑ <br /> S1N3W1atldWOJ JO# la AlIJVdVJ <br /> 0dW/3JA1 )INV1J11d3S ❑ <br /> :Sd3A0'IdW3 d0 a3BWON :SWOOa038 d0 nae WON <br /> a3HJ.p ❑ 1tl1383WWO3 31A113 OJIM 14 11VIld <br /> ❑ 3JN3OIS3a ❑ =3AM3S 37tH NOI1V33V1SN1 <br /> n <br /> NOIJJnaJS3Qo JN33AIItlNa317Y/03No1S3Q a33N1'JN3 ❑ N011100VMIVd3a W3JV7d3M 0� NOLLV77VJSN <br /> LL #NOI1VJllddd 3SO QNV'I 1 M3N ❑ :HMOM do 3JAl <br /> #1IWM3d'O"run8 _ q 1S31 JM3d <br /> A X salalnpJaoJ :NOIIV1VHO.,N11VJ1ndvaJ037 U <br /> :HJd3Q 318 V,1,a31VM <br /> 31VQ NOIIYHIJX3 a3BWnN - <br /> `./ 33"10 9£-3 O Zt'-J❑ 3SN3311 <br /> -nnT a017Va1NOJ <br /> - ao.uvalHOJ <br /> v`Z . /{' = SS3aOOV a3NMQ <br /> � 3NOHd <br /> 4 / 3WVNa3NMO <br /> 32191331#Yd t,._ 06,y NdV <br /> ;ro <br /> Q3nSS1 31V4 Wpad IVAA I brAUIdX3SNOI1J3dSN MOd ` V ssiaaay vor <br /> OZC£-89Y(60Z) - ZOZS6 VJ N01X '�-1d £ 3Ay a <br /> Jo I L69L-£S6(60Z)'1'7yJ JUINUM 37MVQµpd3a,"pj , <br /> ® ' 383M 3 90£ <br /> LIL1I?Idd b1I�LSAS LI�I�W LV� IN311vJ.IIVd3Q H11V3FI 1V1.N3WNOalAN3.U.NflOJ NInbvor NYS <br /> /%'. L 21�LVMg,LS VM H.LISNO <br />