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<br /> -APPLICATION FOR PERMIT
<br /> SAN JOAOUIN;LOCAL HEALTH DISTRICT ;
<br /> 16Q1 E:HAZELTON AVE.. STOCKfON�'CA
<br /> � To*)iofte (209) 466.6781
<br /> PERMIT EXPIRE$1 YEAR FROM OATS ISSUEDtx M �ya '' ,ft
<br /> (Complete In Tfiplirrate)T.�.�s �, r �,a,� ' +,��.
<br /> !�APficetion b hereby made to the San Ioepuin Local Maalth District for a psi dt to t aantct a�+d/or YutYti 1M rw�1t' :;Tltla b
<br /> NI nada Inwith San Joaquin CeuntY Wdirtance No.SO for asweps or No 1442.faf vvatllputnp and the Ftufaa and RaplYatktria of tltfi6atr'Joagirk+
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<br /> J �wt+ar'R Nsfr�� • Add" 472//
<br /> �, "frac a ."• Address�„�� � License No: �h011e � ,�.
<br /> fi TYPE OF, rl1MP: NEW WELL © + WELL REPLACEME O 9i" DESTRUCTION O ; 'r
<br /> PUMP INSTALLATION D"" +• SYSTEM TI AIR O, OTHER- 04
<br /> µ ' x'ft5"C'EAREST: SEPTIC,TANKk �,�-«S �' ES . DISPOSAL
<br /> iFI.D .P�ROP.ELIIYE +' �,
<br /> FOUNDATION' 's r AGRfC LURE L __ .tet bTkER WELL- iy PfT81St1MP8'" ;fi
<br /> a, iF ENUEO USE TYPI OF WELL! PROBLEM AREW STRUCT:ON SPECIFICATIONS{
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<br /> w. �..�„ ski f Depth >'� FRlar MatariN fBalow W l ^ `' a �.W
<br /> Or-,:SEPTIC WORK: NEW INSTALLATION IJ REPAIR/ADDITIO DESTRUCTION 14 INo taptle
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<br /> ,of Ivlrq finks:_ I Nurnbar of be0oon
<br /> i+harat Ne!'ae#.to,a depth of 3*mw. ,'Vlhtar faE ht' v+� _"
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<br /> ihst I have this and that the will be done in aeebrArnca v0 San colic
<br /> "1�ileablr cartHl!' preparod appNcation �� y o+dk>flrtcss.stat+hevti trSd ;
<br /> #u4s. time of the San JoKPA Local 1 Wti Dittrict+
<br /> ;.. 'ftorna liaoanaad agent's vigna""arHiflaa the felowYq:-1 eatlfy that In tM petlorntoriaa of ihi'wwk far%ir/ilch tkla pas i Is lawnd;`i am rat�•4 �4:
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