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JAN-30-1456 14:40 ^1 ENVIRONMENTAL AUDIT, INC TO 7551232120546E34-3 P.03 <br /> ENMONMENTAL HEALTH DIVISION i <br /> P D R=18& 445 IL SAN J13AZOIN ST, STOCKTDN, CA SS721ZU i <br /> (2091 Au,= <br /> tO14RE�RDARtE PERWr EVPIRES 1 YEAR IRON DATE ISSUED <br /> Kma*u in TryFinatml <br /> Axptivtiw.. is here try ande to the San Jesrjin CovtY '.sr a Posit tc constrxt and/or install the work descri Eed. This ateLieatim is <br /> made in calie with San JDsq in County Devel�ellt Titl-, Chapter 5-1115.3 and the Stardares of s= Jowwin cw ty Piratic Nes!-� <br /> gant <br /> sarvic�, EmirommentaL Nealth Division,. <br /> Job Aiidress/er APRs 5400 Pacific Avenue City Stockton Parcei Sitm/APY014 <br /> wxr•s N. Mont. Ward & Co, Inc. Address 1331 S_ H rhTr Rltn-1_ , F'i,1la,trm Phorx $21 A-773-62 7 i <br /> CatractorEflLnlrOfIITIP.11ta). Audit. InG_ Aairwl(I(Xl-A I]3�a?a D'cn4- a3md.jaLid 606348 "are, #714-632-8521 <br /> S& cmcm=or V & W-nri l l i ng AcdressB7 ,S'I Rio Vista, CA Lia 658786 Phare 0916-F,"i,l-71 F5 <br /> "PC Or WELL/PVi>+ X NEW LEU ❑ It *WITdtivG YELL f 8 ❑ OTHER <br /> i <br /> ❑ DESTRUCTION 0 OJT-OP-SEMM WELL 0 GEOPMICA. WELL ! ❑ SOIL BORING <br /> X INSTALLA.TICW C IELL S-vv REPAIR 0 CROSS-C.7INECT REPAIR U VAPCA EXTRACTION :E- 0_- <br /> 0 NOW ❑ Revsir N.P. DEPTH flaw SET FT. FIRST PATER LT-'TEL <br /> (TYrt OF KW) <br /> RT"DED USE Trf OF WFi1 CONSTIUCTiOR 3sem ICAmoms >\� <br /> 11 " <br /> ❑ INDUSTRIAL 0 CPU ;OT—,W DIA.. OF LfLL EXCAVATION DIA. OF CC7I =GR CASING �rN/�`� <br /> ClDOtESTIC/►RIVATE X) GRAVEL PA=/SI=_ -,rn OF CASING/srTEL PVC DJA. OF YELL CASIWG 411 1L <br /> ❑ PUBLIC/K;WICIPAL ❑ DRIVEN DEATH OF GRUIT SEALF • 48' SPEC3Fi CATION y <br /> ❑ IRRIGAT]ON/AG ❑ OTHER GRCUT SEA INSTALLED GYV & W Lk.'7� GROUT Ba AM NA71EDnrt 1 anrT . 7tI[P II ;rte <br /> g }IOIiITORING <br /> 70 ' <br /> 7 D 1 GRUTI SEAL P XM-. Y- Yes ❑ No C7itDtETE PEDESTAL SY DRI'�ER= C; Tes ❑ No <br /> AP}iDY.DEPTH EGGING C7R= imrs-mVE PIPE - Q <br /> PROPOSED C X7=CTIOimmttrsG IIPTNOD: N= ROTA _ AIR ROTART_ A=R X CARLE_ CTRER_ <br /> 1� <br /> ! hveQy cer:fty that [ have prepar% this a ;'cat,m ant that the work wi It be done e'ca <br /> in srcance with San J0a,=ln CxnT:' C:inort-rz, <br /> State laws, and Rulta and ReSulatiarc of thht San Joaotin CotSftY. Hoerr owner or licerord agtrit's sigmture certifies the fetlewirs: ^! <br /> cutify that in the performartr of the work for vsie' i'is PerOnt is issued, I shalt rat eaoloY persms SUDIe Z:t-- =33WW'S C�tPcySA:iCN I-y- <br /> Laws of California." Corrrarors hiring or sisrutum certifies the foLiowim; e I certify that in the PerTorsres <br /> of the .rork fa, which this Ia!rmi: is issuad, ! iali Braley Persons Sci;jec, to =R33iANrS CWEFSAT IOU LANs of Ca!iforni a.• i3E APPIIC:Xi i n <br /> .ilUS7 CALL 24 KUM IN ADVANCE FeWlIrUOU MSFECTHIRS AT 12091 443-7d?3• ccaotete drawing at lower area Provided. <br /> -f--_ Brent Mecham Senior Pr ect e 1- j <br /> SisnmG X, n P.w/I M- 7it1a_ Oat396 <br /> li ' 1 11 ! iII i IIII li i ! I I� <br /> Ili 14 111111 I II iI IIII f <br /> DEPAR IKEIFT USE ONLY <br /> Apptieatim Accepted 8y <br /> Date / ✓/ 7 v Area— <br /> Grout Inspectim By Date Ping insvec.im by uData <br /> Ccaoents �J//� N ^" <br /> Oescretim irspectim Date Sy <br /> 1=11)(Tum ONLY. AIDO FAR N <br /> Ito <br /> PE CODES I FEE INFO AxuuKT REIQTED I OLELTr,CASH RECEIVED BY DATE I PE2Wrj8ERV=l REQUEST NIIElRER , INVOICE I <br /> 3� 1Q1.14 I 356 ao 113z3� /-3d-9Gi ,Eld 38Z �`' <br /> I i 1 1 <br /> I I I 1 I I I <br />