Laserfiche WebLink
I, <br /> PUBLIC HEALTH SERVICES- <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Karen Furst, M.D., M.P.H., Health Officer c ... •..�P . <br /> 304 East Weber Avenue, Third Floor • Stockton, CA 95202 Q`'fi6R`' <br /> 209/468-3420 <br /> PUBLIC WATER SUPPLY PERMIT APPLICATION <br /> 1 �Y <br /> Application from 4v (, - enc' _ <br /> (Name of utility) <br /> Applicant <br /> (Enter the name of the legal owner, person(s), or organization) <br /> Address .SWC W JI(.[XC) . _ _ q6'1 <br /> (Address of legal ner, p rson(s), or organization) <br /> To San Joaquin County Public Health Services, Environmental Health Division: <br /> Pursuant and subject to the requirements of Division 5, Part 1, Chapter 7, California Safe <br /> nrinLinn WnfPr Ant n�f1�Q.('vl..fnrnia.-7 oal.th_anrlSafQtv,,C.nrlo (f'L3�(-Z.rr�}�tinn to Inmactin <br /> TONY COYNE, INC. D M 5090 <br /> DBA COYNE CONSTRUCT& CE��(�E <br /> LICENSE NO.373868P.O. 2701 <br /> nn <br /> ODI,COAX 95241 OCT <br /> 1 1 ZGGG 90-844-1211 <br /> JNNNN <br /> PH.209-333-0404 DATE r Y �� <br /> PAY ENVIRONMENT HEALTH <br /> TO THE �. —PE M IJ—KRVICES I $ �� . <br /> ORDER DF J Y y I <br /> —DOLLARS <br /> FARMERS&MERCI IANT5 BANK ISI <br /> OF CENTRAL CALIFORNIA <br /> LODI OFFICE <br /> LODI,CA 95240 <br /> FORit <br /> C.�IlLY1 _ <br /> III 00 090W, i, L 2 1 L0aL.4 L1: 00 18 276 LII' � <br /> ... — <br /> T�w:�=- _- <br /> �__ _ ---,,.fJ"�� -��nlG '"•ss���-' - -._tiiC:v]�91.--��35'['^4..:ltl`.-..- 'U['lsi+:4�fiff'—��� <br /> I (we) declare under pezjury that the statements on this application and on the accompanying <br /> attachments are correct to my(our) knowledge and that I (we) are acting under authority and <br /> direction of the legal responsible entity under whose name this application is made. <br /> I <br /> Title or param <br /> Address <br /> --Phone (day) �C`�r `` �r �;—� -Phone (night)_���� <br /> A Division of San Joaquin County Health Care Services <br /> i <br /> r <br />