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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE -STOCKTON CA 95205 -6232 (209) 468-3420 <br />NC)N-RFFIINnaw F PPOUIT nlnh.i CYI]IDCC 4 Veao a .. r%— 11-- <br />I <br />nc— <br />Joe ADDRESS to O I G I-1 Vit —4—j K CITY/ZIP V� � r 1 C1 j C, j�2 <br />CROSS STREET KC VI Vlt ', C-✓, t,' E — -% J� <br />K D APN o�4 U() I C 1 rX C) PARCEL SIZE 7 � LAND USE A►PLICATION a <br />OWNER NAME M0,�i- .54'IV) ) <br />Son PHONEJo9A)7-R3q <br />C <br />OWNER ADDRESS J A M CrTY1STATEZP % =N M e - <br />CONTRACTOR `. )'T PHow 2C J 3CA -2779 <br />CONTRACTOR ADDRESS vQ CITYISTATEZP 11 1 CA <br />SUBCONTRACTOR/CONSULTANT PHONE <br />SUBCONTRACTORICONSULTANT ADDRESS CITY/STATE/ZJP j% <br />LICENSE I: C-57 C-61 D-09 L Other NUMBER I ,. EXPIRATION DATE 7' J I '^ <br />BILLING PARTY: IOWNER XCONTRACTOR SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING:/General Mineral/Coliform Bacteria (4391) X Dibromochloropropane (4392) - Arsenic (4393) <br />; <br />