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<br /> WELL. PERMIT APPLICATION FORM LJNI I' IV
<br /> SAN JOA,QUIN COUNTY PUBLIC HEALTI H SEl VICES- `h�- `� � # L)
<br /> ENVIRONMENTAL HEALTH DIVISION ("PHS-EHY) t 9 1
<br /> 304 E, Weber, 1 hard Ffoo� , Stockton, CA.. 95202 � �
<br /> (20,c,) 468-3450
<br /> NON REcLi'XIABLE PERMIT EXPIRES 'i TEAR FROM DATE ISSUED }`rh^'`, I 1 + � �\/L
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<br /> NOTE O FSiTE BORINGS REQUIRE Ar.CESS OR ENCROACHMENT PE( MIITS
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<br /> Ji PE coo] FEE INFO I AMOUNT REMITTED CHECKMCASH RECEIVED BY DATE PERMITISEPVICE F=EQUESI NLFI'tiat_R IN'10^F
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