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San Joaquin County Environmental Health Department <br />WELL & BORING P ERMrr APPLICATION SUPPLEMENTAL <br />JOB ADDRESS: 8020 S. Airport way. Stockton. CA PERMIT SR # <br />LICENSED CONTRACTORS DECLARATION (LCD) <br />I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) 1 <br />Division 3 of the California Business and Professions Code and my license is in full force and effect. <br />License #: 2 ri-0 p,Gq Exp Date:J�,TiJQ1; oa <br />Date:Lima-, \9--, Contractor: <br />Signature: Title: <br />Print Na <(72t.i <br />