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WELL DESTRUCTION PERMIT <br />PUBLIC WATER SYSTEM ❑ Yes ❑ No <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS n G 10 (f C1 V ^] + r CITY/ZIP <br />CROSS STREET ��� ��� 1 �; I i �� APN J L1U !� / V I C % PARCEL SIZE %'�� )AND USE APPLICATION # <br />`, <br />OWNERS 1. (rl V PHONE ' -u ��� ��ci L C� <br />OWNER ADDRESS 1 CITY/STATE/ZIP <br />CONTRACTOR i Vc 1 ((f7 PHONf�Cl�1) . C-11 Dq <br />y <br />CONTRACTOR ADDRESS �() �� Li 'A. { ` I CITY/STATE/ZIP K'1\y'...�Y-• <br />i <br />