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FOR OFFICE USE: APPLICATION FOR WELL OR PUMP PERMIT PERMIT NO. 7,2 - gF <br /> (Complete is Triplicate) Date Issued: Z_: 2$ _7 f <br /> T IS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ,APPLICATION IS HEREBY MADE TO THE SAN JOAQUIN LOCAL HEALTH DISTRICT FOR A PERMIT TO PERFORM <br /> THEWORK STATED HEREON. THIS APPLICATION IS MADE IN COMPLIANCE WITH COUNTY ORDINANCE <br /> 'NO. 1862 AND RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> South side of Highway 4, 1 mile <br /> JOB ADDRESS/LOCATION: West of Kaiser,_ __ _ 2101 in f i e d CENSUS TRACT: T-1-N R-7=E ,fie C. <br /> OWNER'S NAME: Mrs. C.M. Manetti PHONE: 465-7138 <br /> ADDRESS: 1131 Oxford Way_, Stockton Calif. CITY: <br /> CONTRACTOR'S NAME: John L. Panero Jr. LICENSE # 120724 PHONE: 8 8- 5 - 00 <br /> INTENDED USE: INDIVIDUAL DOMESTIC WATER WELL / / PUBLIC WATER WELL / / TEST WELL / <br /> IRRIGATION/LIVESTOCK/AGRICULTURAL WATER WELL /F/ INDUSTRIAL WATER WELL <br /> CATHODIC PROTECTION WELL/ / GEOPHYSICAL WELL / / OTHER / / <br /> NEW WELL: DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES PIT PRIVY <br /> SEWAGE DISPOSAL FIELD CESSPOOL SEEPAGE PIT OTHER <br /> REPAIRS: TYPE OF REPAIRS: Deepening present depth 360r' <br /> ABANDONMENT/DESTRUCTION: METHOD TO BE USED: <br /> PLOT PLAN: SHOW ON REVERSE SIDE <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN <br /> ACCORDANCE WITH THE PROVISIONS OF THE LAWS OF THE STATE OF CALIFORNIA, THE ORDINANCES OF THE <br /> COUNTY OF SAN JOAQUIN, AND THE RULES AND REGULATIONS OF THE SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> SIGNED: CONTRACTOR: <br /> FOR DEPARTMW USE ONLY <br /> PHASE I <br /> APPLICATION ACCEPTED BY. DATE: <br /> ADDITIONAL COMMENTS: <br /> PHASE II PHASE III FINAL <br /> INSPECTION BY: DATE INSPECTION BY: DATE <br /> i E H 1426 L SAN JOAQUIN LOCAL HEALTH DISTRI 1172 1M <br /> DISTRIBUTION: WHITE-HEALTH DISTRICT - YELLOW-PROPERTY OWNER - PINK-CONTRACTOR <br />