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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> °J t 1601 E. Hazelton Ave. , Stockton, Calif . <br /> FOr_ OFFICE USE: <br /> Telephone: (2(7'J.) 466--6781 <br /> Per <br /> No. -71G <br /> APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT - -� <br /> d <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED . _ Date Issued _ <br /> (Complete In "Triplicate) <br /> Application kation is hereby made totheSan Joaquin Local Health District for <br /> compermit <br /> liancetwithconstruct <br /> Joaquin, <br /> and/or install the work herein described. This application he made in p <br /> County Ordinance 'No. 1862 and1the Rules and Regulations of the San Joaquin Local Health, Distri'ct. <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATION I R� 6 �.f�/•tiP� <br /> Phone 4-17-30 0 <br /> Owner's Name <br /> City - -- -- <br />