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WELL-vERMIT APPLICATION FtYAM SITE <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> MITIGATION <br /> 8 AA '�R <br /> VN ONMENTAL HEALTH DIVISION (PHS-EHD) UNIT IV <br /> APR <br /> 0 RRf E. Weber, Third Floor, Stockton, CA., 95202 <br /> A�N?NDN oPSt iE (209) 468-3449 <br /> �{ �7M�wY <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/or install the work described. This application is made in compliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Public Health Services,Environmental Health Division. <br /> Assessor's <br /> WELL Location '�.�I DS W• �Pll jg-;,I Dr. Cross Street Q i wtC t City 4,4&k, 0:7 Zip Parcel# 0 5 T—JOO <br /> PROPERTY Owner 6kv— Texaco FM e- Address j>061 SodInaer G�o:� City �Irlll ""V"j Zip 'IM13 Phone# '125' c1 b Z-15 72 <br /> egSca�G D+^ '1`i <br />