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e SlanCh A P N cq‘os-oo6 <br />OSA-DC\ kM) son <br />7Z . %ars, P.4 <br />trt. <br />SA N JOAQUIN COL NTY <br />EN VIRONMEN iAL <br />HEALTH DEPARTMENT <br />).3a LAND USE APPLICATION # PARCEL SIZE <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT Www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />4512 Rc <br />CONTRACTOR ADDRESS a <br />SUBCONTRACTOR/CONSULTANT <br />SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP <br />PHONE <br />CITY/STATE/ZIP <br />LICENSE k C-57 0 C-61 0 D-09 0 Other NUMBER (1) ep EXPIRATION DATE //c3i/.2/ <br />psi <br />2 A- -7 ni1 ied <br />Area CO/ Employee ID# HZ <br />CI SPECIAL Well Permit <br />DEPARTMENT USE ONLY <br /> <br />Application Accepted By Date #9/20R0 <br /> <br />Grout Inspection By Date <br />ft <br />Pump Inspection By cicq4.5 to Derse..k.• flik1.1. Date 51C 12i7t 0 WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth <br />COMMENTS <br />EHD 43-06 6/11/2019 WELL /PUMP PERMIT <br />4e- 1.•••^.11 <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted Date i . <br />Permit/ <br />Service Re uest # Invoice # Well ID# <br />4(11 .3 050 Dol____, ito4DI 3? -7 Tv° uipvi 7 <br />PHONE <br />95z /5 <br />BILLING PARTY: 0 OWNER %CONTRACTOR 0 SUBCONTRACTOR/CONSULTANT <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />CITY/ZIP _SiirdiAln__q_521 <br />PHONE qL72..b <br />lzxkJvr1 CA 95-zio :SS32,100V 311S CITY/STATE/ZIP 3