Laserfiche WebLink
WELL DE`TRUCTION PERMIT <br /> PUBUCWATER SYSTEM G..._-< 0 K <br /> SANJOAOLVr COHNrr ENJYtlMMNTAL HEALTH DEP,wr T 600 E MIDI STREET.SitNJfRM CA 95202-(209)469-3410 . <br /> NON-REFUNDABLE PERMIT CALL 208 953-7897 FOR IN EXPIRES T YEAR FROM DATE ISSUED r" <br /> JOa ADD Er IA) C"" D <br /> Caosa STREET r & e— APN —O 0—S I PARCEL SITE_Luo tIr AtNNl4Tlnl i o -x0� „Q v "d <br /> oMe 11'lo kc 114 mint wE r Sc..L.00 I Go r to PxpxE a 5� 01i <br /> OwlrlApraa O .B1n�I qj CnVil! vLP LO -5 of 0 2 <br /> N� v <br /> CONTRAC'mi V .1• VJ -131111 11 L racy^ PHUHE IBA b,1— bbp <br /> CpetaACrol.Aeollae p P7d x CmisTATE2n L.DcL, C= O <br /> X Cd7W9LI)Nsl L¢oub Nusiwut X040 4 El ..T GATE 4130 7010 C-71 C:) �1 <br /> mYn OD <br /> PueolunON CnI1RACTOR PHONE f I <br /> Pratfall CONIRKT011 ApbRFSs Cm19TATy.2V <br /> ❑ C57 Wall Oiling Lk mss lslw b ExpaHpn Dale <br /> ❑ 9v u of Alml ol.Tobacco and FPaarms-glees of High Explosives Lli Number E>piratbn Date <br /> ❑ CHP Hammoua Materiel TansPonatlm b Ex" L uwmaa Number Expiation Dews <br /> ❑ San Joaquin County Shenft-Caonu Explosive Application and Permit Llcsnse Number Expiation Date <br /> ❑ Ca91Wmi Ocuiptbnal Sally Health-Bbsbr license Number E�Oabon Date <br /> ❑ Dry ❑ R@PhKabnlK Wd1 ❑ Caved In ❑ PN Weil InxLve ❑ Test Hde <br /> wissipsoledwZa. C+to. L.L I I - PWa+R6.. lar w...3 A+r LLs 6P14 <br /> •9a 1} PI IfWa\aININRYMIbrP! tr. uare�va <br /> Knowe SoiNYaler wManNnutb at adjacent property — <br /> ❑ Op"Damxa ❑ Orer���IEaP�aLrmy11r ❑ Unresee ❑ Omer <br /> WM Wil La Py alli 13 Y" ❑ No Wool sW ❑ No x YMNlyy_ft Debw Vwnd surfacs(bile) HobDWrNw� <br /> Wr CarM1retarcas"❑ Yr ❑ No DpmdCoiadi a�r,,_-Cadq bay, <br /> Wr DInrlMerMC9rrdlNAor Cssbq YKltr <br /> Ceaft caamabr O�y ocnaa Tote Dapm3rr rys cpm mwd A Daps M CWnE ftbpa <br /> Sealb9Mery rmm C fibgsb_ftbgs `R UNUM It bus b Rb�p <br /> WN caaln9 to be IfMrlionslad by one of the Iof -ima methods: Rare R bila b S egs <br /> ❑ MMb KrYb Number d ab eery ft and2r <br /> ❑ ExWoNvaa❑ Dabonaenp mrd ❑ xis pgstlar sully ft O xenwl pmootoa <br /> ❑ Dabrutirlg mrd arW bLnslers ❑ Wm pm)eWles e. y ft ❑ x t p jeU9a <br /> ❑ tele _ <br /> Sa,i-- ❑ Nat CMnem(912 bay66 gat Nater/IJ Sand Crrem sect mw/7 gaf Y her J Bemomb PNNb <br /> ❑ Benbmb CM voll Manula w Spec%sail_% Nemo ❑ Specs w Fila ❑ Spent Suprnnmil <br /> Plaoanrrlt 11116"aad ❑ Pumpad ❑ Free Fall B carer <br /> Sri CornpleRdn ❑ Campeb xis Mushroom Cop_N bgs J Cornpbb b EaMn9 Surface Pad <br /> I HEREBY CERTIFY TKAT 1 KAYE PREPARED THIS APPLICATION AND THAT THE WORN WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAOIRIN COUNTY ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REWIRED LICENSE IS <br /> CURRENT AND ACTIVE WRIT THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> ��I�IIM�Uy 244 HQU�R V CE NOTICE REQUIRED FOR INSPECTIONS <br /> GONMALTORe SpNAIRM _._� TITLE 7P.viNe,.,/ <br /> well <br /> ................_........ <br /> ...... i <br /> s <br /> t ' <br /> QEPARTMENT USE ONLY �� Y <br /> Application Ampbd Ey ab 4 O 3 Ana �T� <br /> DeeVuution Dab Employ"loll <br /> COMMENTS <br /> PE Cody Ito C!" RaMMad Dace Sarvlw i ImRlri WNp <br /> �f ssNJ <br /> 5 DoNL � 3 3zS <br /> EIW A9-0e nNKI WELL DESTRUCT PERMIT <br /> 16MVU] 1 <br />