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WP0041405
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CEDAR
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17710
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041405
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Last modified
6/7/2021 2:54:37 PM
Creation date
6/7/2021 2:52:22 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041405
PE
4380
STREET_NUMBER
17710
Direction
E
STREET_NAME
CEDAR
STREET_TYPE
AVE
City
RIPON
Zip
95366-
APN
24514006
ENTERED_DATE
11/2/2020 12:00:00 AM
SITE_LOCATION
17710 E CEDAR AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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LICENSED CONTRACTORS DECLARATION <br />rdf6ssions Code and my ficense is in full force and efrecL 5(cOMMencing vAM Section 111 DiwWon 3 of the Buskiess and <br />leense <br />�4 Expiration Date <br />OWNER-BUILAER DECLARATION <br />,.«• .I. <br />as <br />Pea civil nalty <br />Um <br />five hundred dollars11 1 _ - nra - _ <br />■ with = sole com <br />Expiration Date <br />Company. <br />CERTIFICATE OF EXEMPTION FRONT WORKERS' COMPENSATION INSURANCE <br />� if, after maldril; this Certificate of <br />ON LENDING AGENCY <br />DIVISION OF INDUSTRIAL SAFETY PER■StT CERTIFICATION <br />.• _ rl • t . 1 .. r s• . t - •• 1 .' ., • 1/ i , t «(1 ' Y, '1 1, 1 , h - / / ,1 - .1 I/ 1 ,1 4 <br />Til 1 <br />wouio require a permit ftm the Division of Industrial Safety, as noted <br />abovei unless such Person has a permit to do such work from the dinriskin, <br />certify Mat I hme read this application and state that Hie above informahm is correcL I agree ID comply wFth all cdy and county <br />wilinan Aces and slate laws retailing to well construction and or COnSUIA ITTIT aTie rf,=pilot n �• _ <br />- ••:.. r, <br />L <br />�t�a3-az-oo7 uc�s®corarwlciaRs or�utannoN <br />rr� <br />
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