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<br /> I1.' � ��''';"•` `> '�APPLICATION POR SIEI.L CONSTRUCTION OR PUMP PERMIT Permit No Z� /d.2!rl
<br /> + ....f is �� THIS PlWaT MWII=`1`-YEAR FROMI DATE ISSITED Date T$auedr a
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<br /> ';'." l�iPl Cstioa laL.hexaby.atder ta,the 'San-Joaquin-`Local Health. Distii�rict €or a permit to 'ranatruct�, °'
<br /> ,: anotar.stall�th�1111�` rk"har.rsia descxibed
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<br /> r_ � :-_. ... r Thio a plicatfom is made Inc Bance'with San Joaquin'
<br /> "3� 'C ► a.ardinancsY_. 8pzan(�% ,a, the;Rules and ReguLtiona of the San Joaqui�Loca1 Health Dist1.rict.
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<br /> aE" ndwtrisl ,x Cable.Tool 1. , Dia.;'of Well• Excavations ��
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<br /> -I heieby;{agree to coa+plyt;with all laws and regulations.of the .San 'Joaquin Local }iealth:'District
<br /> " , aaduthe State of California'pertaininp'.to oL. r regulating well`coastruction I.ithin FIFTEEN DAYS
<br /> El I.. after; coag�leLioa'of my stork o1.n a..new, veil, i rill` furnish the"'San :Joaquin Local Health District a T
<br /> �,IiBLLDItI1.LE8S REPORT'af ,the cell aad'noCify them,before gutting the well in use The above 1
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