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1. <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN LOCAL*HEALTH DISTRICT <br /> AV <br /> 1601 E. HAZELTON <br /> . .� E., STOCKTON, CA <br /> Telephone (209) 466-6781 <br /> 5 •. PERMIT EXPIRES 7 YEAR FROM DATE ISSUED <br /> (Complete in Triplicate) _ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is <br /> made in compliance with San Joaquin County Ordinance No.549 for sewage or.No. 1862 for well/pump and the Rules and Regulations of the San Joaquin <br /> I Local Health District." <br /> Job Address '�i� &0 �+ •,.�. .j� <br /> C City .s T Loi Size ,�,I� <br /> = t.. - <br /> f -Owner's Name rr1' <br /> - <br /> { Phone 'y <br /> Contractor i ;" <br /> Address <br /> /^ g t <br /> s TYPE OF WELL/PUMP: - Ll.ce_nse.No.4 y ,,, <br /> NEW WELL i Phone <br /> WELL REPLACEMENT ❑ DESTRUCTION ❑ ; ,' <br /> PUMP INSTALLATION Q SYSTEM REPAIF;1❑ OTHER ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK ��® <br /> R SEWER LINES L +m i <br />