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APPL)CkTION 'C; Oh'O_RCRO'JND PIY_wG 2F YASR PERMIT <br /> '.tIS 7E,21Y:: .X?:FES 90 DAYS "C.y T}_ A7PROV yX-'_ DO NOT UR(:I IvAgrSHAOZD ARIAS- IvJ:UM PERY.IT„PE <br /> _:11K RE-Z-Oa IT PIPI.c rxrj SIt <br /> I Ea♦ SLTS Y ! 7ROJECT COtrr'AC' <br /> 209 461 -6337 <br /> PHONE A <br /> C i :UDR£S'+ <br /> I { <br /> L { CROSS STItSE ---- <br /> 1VH09Z <br /> 1 <br /> CLWIRACTO,Z <br /> O ELITE IV CONTRACTORS, INC. g 209 462-6337 I - <br /> r, I C(W:7- <br /> REss 25,35 WIGWAM DRIVE f Ca LIC 2 6 6 0 01 6 <br /> 'r1 cuss A,C, 1 0 ,HAZ i <br /> R ! INS <br /> A { RX.COrtP-' 046-008761 I <br /> z I t <br /> O { <br /> ,R I PliOtrE 3 I <br /> :tf if...l:/..ltlr.tif.[..l►,.. f rmtre 2 <br /> 11(31/Ili 1[1(/[i.1/l([3lt itllt <br /> SIZE - Qa'Ff:ZGLS Sj-(W D CTIRRE,rmT/PREVIOOSLZ DATE u5: SXSlALLD <br /> A. <br /> 1 3YI _I I <br /> I » <br /> ife+;IfIfill 111111111IIIIIl1IIII[[IIII1IIIIIlit-life!!fill Ill11111111II1111111,��I111IfIililllllfillltlllilEl1tt11l1lIIIIillill� <br /> . _• / _ _ APPTOV-sD APPROVED wx"Rh1:1Z:,':fk; nISAPPROVFD I <br /> y L) 1 <br /> .Z I 7$A„Y (ts:Vf>E�S SAKE lq D�.I.E <br /> itllllIII fill IifIIII IiItIAIII1 !t . IIl III�IilitlliltllllllIi1H1I1tI1l1lfIIIIIIitlt�llillllii[[tI 1!111 !illi! liIIIIIIIIi <br /> f <br /> a??LSCaNI' KV+ 2£RFORtf ALL vORX :N ACCCRD7lV(-� ''-'a:T(SAH 3OAOtlIN -mrry 02DyNANCTS. STATE LAYS. lid 2t1i'S 1ST 2FiGOIlpZOh'S OF S <br /> t <br /> SAY 110AQVZlr C7L7+*I'X ?VSLZC IfEa2.-3 SZSVSCs. C'L1_--;OR LICEI(SID AGFY(•S SIG,WTUXE C9STIFIFS THE FOL.�XG, -1 C`.XI':FY THAT _. <br /> 1 <br /> .S�t�RfORMN-C= OF 'IYE vORK FOr 1XLCH TffiS ?�=17T LS LSLF;Dp. I SSW. NCI•rZ.1PLAY ANY PERSON rX Sr.CS A-MURM AS-M d£COKI f <br /> TO 001,72R'S COrtPEN, 1Z0-1: LAWS OF CAL=-C.YNSa.- COKrRACTOSt'S S(22:�tC OR SVBCONLQA�SIGS+A:VR£ CE.TI27ILa Td£ FOLLOvIt:=:1 <br /> !SRI IFY 'M:- U4 TNF' F' O 'vcc OF .HE vUR: FO¢ vSSICK 7ms PEPmr IS :.SSLED. L L F11MOY r'-ZSON:i SU3JECZ•ZO vORAMR,S I <br /> ^;.>r)`f.1`L•;ATION =.s.vS OF CAL: IG-- ' <br /> Yt+f•Ar.T'S SIGY�1'TVRi.. <br /> • i-3�LLIJ�G I�c� •l'JA.7"I�T.�: - <br /> . <br /> medicate the responsible party to be billed'for additional PHS-f ID staff time expended beyond <br /> �E :Trait payment coverage per tanrlk_ If the party designated below is clifferent than the perni.t <br /> �Dplicant, e:-q- property owner, �'Ie party must acknowledge this responsibility for the billing <br /> �v signatu:e d date below. <br /> N ^,. ss� l C -a <br /> number -1(JL <br /> ature <br /> 23-003604 <br /> 61 <br /> t � • n '", _ e Qq1� *�( I G��U <br /> lI-et"l(-A Cl,- <br />