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APPLICATION FOR PERMIT Ce <br /> l SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> :I <br /> i' 1601 E. HAZELTON AVE., STOCKTON, CAJ " <br /> I' Telephone (209) 466-6781 —` <br /> 4 PERMIT EXPIRES TYEAR 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 /> Local Health District. ) <br /> Job Address d J City Lot Size PM <br /> A� prrrc��t jj <br /> Owner's JName ��- Address !Phone <br /> € Address .?S icense No. ��U�`3 Phone <br /> Contractor _ <br /> TYPE OF WELL/PUMP: 6f NEW WELL ❑ WELL REPLACEMENT DESTRUCTION ❑ C.c�� +xl1x �uti t <br /> PUMP INSTALLATION El SYSTEM REPAIR El OTHER CJ)�S p% <br />