Laserfiche WebLink
f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FOR OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466-6781 <br /> PLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. Z-(a <br /> THIS PERMIT EXPIRES ,l YEAR FROM DATE ISSUED Date Issued <br /> (Complete In Triplicate) <br /> Application is. hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. This application is made in compliance with San Joaquin <br /> County Ordinance No. 1$62 and the' Rules and Regulations of the San Joaquin Local Health District. <br /> JOB ADDRESS/LOCATION 97 t3 S, 864 "" <br /> CENSUS TRACT <br /> Owner,'s Name. , Phone <br /> - S` <br /> Address ` City <br /> Contractor's Name ' � r. License # Phone <br /> id <br /> TYPE OF WORK (Check) : ' NEW WELL %�/ DEEPEN / / 'RECONDITION /_7 DESTRUCTION /_7 <br /> AL <br /> PUMP INSTLATION <br /> / PUMP REPAIR/ / PUMP REPLACEMENT <br /> Other <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY i <br /> SEWAGE DISPOSAL FIELD CESSPOOL/SEEPAGE PIT OTHER <br /> INTENDED USE TYPE OF WELL r CONSTRUCTION SPECIFICATIONS <br /> Industrial Cable Tool Dia. of Well Excavation <br /> Domestic/private Drilled Dia: <br />