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WELL PERMIT APPLICATION FORM UNIT IV <br />LOP r <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ' <br />ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) -� <br />304 E. Weber, Third Floor, Stockton, CA., 95202 ORIGINAL <br />(209) 468-3449 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />Application is hereby made to San Joaquin County for a permit to construct and/qr install the work described. This application is made in compliance with <br />San Joaquin County Development Title, Chapter 9-1115 3 and the Standards of San Joaquin County Public Health Services, Environmental Health Division <br />L Location (a ' Assessor's <br />WEL <br />CO'' �f v C 1 �, iS►✓,i <br />