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APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 2009, STOCHTON,- CA.,'9520]. <br /> (209) 468-3447 <br /> pZNIT EXPIRES i YEAR FROld DATE ISSN$ <br /> t (Complete in Triplicate) j <br /> Application is hereby Stade to SaniJoaquin County for a permit to construct and/or install the vork herein described. This <br /> application is made in Comgpiiancelvith San Joaquin County Ordinance No. 549 and 1862 and the Rules aad Regulations of San <br /> Joaquin County Public.Health Services. <br /> !' Job Address _�2 1.23 ���� r �� City f . Lot Site/Acreage <br /> �rA <br /> -79Rik d Owner's Name Address Phone <br /> Address License No. —Phone <br /> Contractor <br /> TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT ❑ DESTRUCTION ❑ Out at Service Well Gl <br />