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SAN JOAQUIN LOCAL HEALTH DISTRICT 4 <br /> FOR OFFICE USE: 1601 E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466-6781 <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. 7.5=5761 . <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued <br /> (Complete In Triplicate) D 070-(L, <br /> Application is -hereby made 'to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. This application is made -in compliance with San Joaquin <br /> County Ordinance No. 1862 and the Rules and ,Regulations of the San Joaquin Local Health District. <br /> sY os� c :i 5o,4R eF //aG -Vc.A) IFWP,5 iAe. aF tri/ <br /> JOB ADDRESS/LOCATION ;�� i O4r�► s,oe. o F -- ENSUS TRACT <br /> Owner's Name 4D,_ _�Eopiy _— Phone 36L <br /> Address yG 7 E,. , 13 Eq-,e Cxc_el< izo City <_0 O 1 <br /> Sin Joaquin Pump o. <br /> Contractor's Name r„• ion of San Joaquin Su: <br />