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SAN JOACUiN COUNTY PUBLIC HEALTH Sr=RViCES <br /> ENVTRONMEiV"f'AL HEALTH DIVISION <br /> P O. 6OX 388, STOCICTON, CA 952-01-0388 <br /> PUBLIC WATER SUPPLY PERMIT APPLICATION <br /> Application From r.5.4s-7,4 U�NEf,�e�S <br /> (NAME OF UTILr y) <br /> Applicant Sebastam= Vineyards <br /> (ENTER i rfE NAME OF THE LEGAL OWNER, PERSON(S) Oft ORGAN24TICN) <br /> Address P.O. Box 1290 Wooa'b=dge Cali forr,a <br /> (ACCRESS OF LEGAL OWNE.51, PERSON(S) OR (ORGANIZATION) <br /> To Sari Joaquin County Pualic Health Services, Environmental Health Division: <br /> Pursuant & subject to the requirements of a1v1s1on 5, Part 1 , Chapter 7, California Safe <br /> Drinking Water Act of the California Health & Safety Code (CHSC) relating to domestic <br /> water supplies, application is hereby made for a permit to <br /> o.eJTr..�el� 7`t7 0�� 2,fr� �u ��r� �r47�e S YSTL of <br /> • <br /> (Applicant must state specifically wnat Ls bean applied g pp ed for-whether 'o operate a water systema, to cons= <br /> c,- <br /> new works, to use existing work s, to make alterations or additions in works or sources. Note Searian 4012. <br /> CHSC, requires detailed plans and speczficatsons to accompany all applications to construct or modify a public <br /> water systems) <br /> Dated Q <br /> I (we) declare under penalty or perjury than the s-.atements on this application & on the <br /> accompanying attac:-Imenrs are correct to my (our) knowledge & that I (we) are acting <br /> under authority & direction of the responsible legal entity under whose name this <br /> application is e. <br /> By +.Y � <br /> i atle F-Xeca=ve Vice PresiaLa-It of ?roauccj.on <br /> Address P 0. Box AA Soncma Cai:.ornaa 9476 <br /> Phone (day) (707) 938-5532 Phone (evening) (707) 996-9691 <br /> 5iaa <br />