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02/19/2002 16:12 2094683, FIFTH FLOOR PAGE 02 <br /> WELL PERMIT APPLICATION FORM SITE <br /> MITIGATION <br /> SAN JOAQUIN COUNTY UNIT IV <br /> ENVIRONMENTAL HEALTH DEPARTMENT (EHD) <br /> 304 E.Weber, Third Floor, Stockton, CA., 95202 <br /> (209) 468-3449 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> pplication is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San <br /> iaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department.Assessor's <br /> TELL Location 3/%1 S Zl`^Cc J r �S?4 • Cross Street City 't'�c� =Zp Parcel# <br /> ROPERTY Owneer[r a� ,c��s _Address /976 (,�i.('�,, r 0yClty fjTC k4,^ ip 9.2.?GSPhone#�Oq-9_-7273 <br /> :-57 Contractor f (Cc: <br />