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Ch <br /> O <br /> 00 <br /> 00 O <br /> c7 .— <br /> O <br /> O N <br /> ar - <br /> O <br /> V .-� " <br /> ' eui ,'r,e.,Ic stnnaese see ..._sack mi, <br /> t c <br /> , 1 s�`: m � nerarda-___..�-t I Accaleator Cnamel.----.—'— <br /> oth - - ChrblY Sox St <br /> Othe <br /> gu,r In <br /> nr m�_ ector HThlck t <br /> n Standing Water t_evel_ <br /> ��j��(M, rete Pedeelel Olmenelon6 Wldth Pump Seim <br /> ��� T�rWne Other_ WO <br /> SLID <br /> DONE IN ACCORDANC <br /> SLIDmnrslble <br /> THAT 1 HAVE PREPARED THIS APPLICATION ANO THAT THE WORK WILL B AM IN COMPLIANC <br /> I HEREBY CERTIFY AND RULES AND REGULATIONS. 1 WILL <br /> �TtI AT.SAY REQUIRE[ <br /> �0AGU1N COUNTY ORDINANCES.STATE LAWS, <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA coNTREQUIRED FOR INSPECTIONS A PLEASE HAT ICALL(209)953ND T 7 <br /> WORKERS COMPENSATION LAWS• <br /> MINIMUM 24 HOUR ADVANCE NOTICE DATE <br /> TITLE <br /> SIGNED <br /> `b 1 <br /> M <br /> vl <br /> t n ' <br /> _ DEPARTMENT USE ONLY <br /> Application Accepted By_`: Y --- - - Dato_ i j_ Area .. - Employee <br /> Grout Inspection By .___.— .---- Dale SPECIAL Well Perm <br /> Pump Inspection By —.--._--- Date WAIVER Received <br /> Soil Boring Inspection By Dale -___._ Constructed Well Depth <br /> COMMENTS_.—_-.------ -- - -- —. <br /> PE SG Raceivad Checkltl Amount [DTate <br /> Codes Info By <br /> Cash RemittedO <br /> coU <br /> L.L <br /> O 0 I <br /> In O Cn <br /> (_ <br /> _ Z <br /> (] w <br /> DO _ <br /> T � <br /> O N O O <br /> N ~ p X <br /> CA <br /> N = O <br /> CD d 0 <br />