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San Joaquin County <br />Environmental Health Department (D N <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd —_ <br />ORIGINAL <br />SITE <br />MITIGATION <br />UNIT IV <br />Well Permit Applicatiog 2007 APP 16 PM 2: 2 <br />NON-REFUNDABLE PERMIT EXPIRES 7 YEAR FROM DA � ISSUED <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work *#ribp0 'jk4q aqq11cVien is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County,!ff_hArpr"0rVd,* IAiPpIg nt. <br />p Assessors <br />WELL Location 0" 6 6 Ivry. Cross Street City Skyck iu,, Zip arcel# li l i (0dg <br />PROPERTY <br />Owner U$ A Pf �'d[[ kvN Cu✓t , Address A i 0 l A� Owrw � b,i S�' �opcityg��ttrg i l+l�i Zip "t3 d l Pho�nie# Ic <br />C-57 Contractor kej,,,4 Sd;r, r.- O Address ZZJ N. t?�J S�• nI CitywouJ (uhd Zip '107 G Lic#ou141� Phone#p16)i <br />