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APPLICATION FOR PERMITLPLP <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. HAZEL T ON AVE., STOCKTON, CA <br /> Telephone (209) 466-6781 \\J <br /> PERMIT EXPIRES 1 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 /> Local Health District. <br /> �ry r <br /> Job Address ce- <br /> � <br /> Y <br /> Cit W n, Lot Size PM <br /> Owner's Name /'DdCrL�J' '�Q��r` Address ��Q ! Q'( p �y Q� l 1`�P Phone 0 J1v <br /> Contractor s_ Lit✓Q1,C4� Address ,J 0 ✓• License No. �?1 ^Z Phone Sy Z -7 4�V <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT DESTRUCTION ❑ <br /> PUMP INSTALLATION ❑� SYSTEM REPAIR El ,OTHYFR ❑t <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLO� PROP. LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELD y . PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICA Iq S <br /> ❑ Industrial ❑ Opei <br />