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SAN joAqUit4 LOCAL MALTR DVSTRTCT <br /> ICE USE: 1601 E. HaZeltOn ' ., Stockton, Calif. <br /> Telephone'* <br /> MnICATION FOR WELL CONSTRUCTIONPOWT Permit « -: <br /> per ' + jta a Weal alt District for t i t t <br /> X110441 1US application to wde in comp j " <br /> 4"14/0'r, Install thaV. 0,14C <br /> tri lam►, '` tli ` t o o t J .. tt <br /> Cos Ina <br /> cid <br /> s <br /> Tye' � NFA / DEQ /- 1 0 <br /> _77PUMP REPAIR <br /> Other <br /> PIT PRI <br /> SWR LMES <br /> GF <br /> NE TTC <br /> Lxc <br /> SXWA= DISPOSAL FIELD <br /> ,. . <br /> INTENDED USX Ty" OF _TR <br /> Industrial Cable Tool Di <br /> Domes <br /> tle/grivots Drilled Dia. of Well Caai�"_ <br /> tr/ ' tic Driven Gauge of Casing <br /> Irrigation Gravel Pack Depth of Grout <br /> Cathodic I'voteetion RotaryGrout <br /> -Disposal Other Other tip <br /> -Geophysical r <br /> PUW Out Contractor. <br /> T-me at <br /> AW XVLAC Stat* Done <br /> AEr 8iit+ Work Done <br /> 1 ` CTt stall 014010ter ApprOM"t : <br /> Ono <br /> an <br /> d the stat ��r� a t las to or regulating well c t +�ti .tom y <br /> of tar cmvletioi o � � s, I will rail the San t� t3i,�trlet <br /> notify,them + ttt the..P � <br /> information is true to. tie.beat of my koavledee an belief. <br /> OSPEMON. <br /> TITLEr <br /> (DRAW PLOT PLM ON S SID& <br /> FOR DEPARTNEW DSE ONLY <br /> EMS <br /> APPLI 'i` �ti 3Y D <br /> 1 1 <br /> INSPECTION 'BY DME luspecrioNi <br /> t� <br />