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P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON. CA 95201388 <br /> (209) 468.3420 <br /> MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete In Triplicate) <br /> APPLICATION IS 14ERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WIIII SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSOR APNJ 045 -0-3-1 -02- CITY ��( PARCEL SIZE/APNI / <br /> OWNER'S NAME \a <br /> t 4 CA AODRFS.DW KI.: PLAZAV{LjK� &>(61ONEI <br /> .'1v�L3�7YlAi i i p p-�S�1 1 �h^.itGu`z PrG G`; TC.1l <br /> r"1CAj— LA nl��/,�r(,fes ADDRESS_TC(I�;�C.V IL.LG, n51p,-11l LIC/_ c� _PHONE/411D�1�3'Zic Op <br /> SUB CONTRACTOR,. �{✓.'fV�-MAI l-X`. D�Ly�I�+G' I ry C�• ADDRFSS�(�j �1�SAAJ�C3'� v�.•CA LICI1{:3q U 36 PHONE Af ka- "II <br /> TYPE OF WELL/PUMP: ❑ NFW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL I ❑ OTHER <br /> ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL a j <br /> ❑New 11P.P.Ir H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL O <br /> (TYPE OF PUMP) '�7�� /� �-yy, <br /> ❑ OUT-orWELL ❑ GEOPHYSICAL WELLI SOIL BORING �• 20, iAj bee 1T g <br />