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C� <br /> "N JOAQUIN LOCAL HEALTH DISTRIC- <br /> FOR OFFICE USE: 16(.._.E, Hazelton Ave. , Stockton, Cain . <br /> Telephone : (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued //_2.,7 <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 Joaquir <br /> County Ordinance No. 1862 and the Rules and Regulations of the San Joaquin Local Health District. <br /> JOB 'ADDRESS/LOCA�}0P1 �5112 IrIE ,/h'j <br />