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SAN JOAQUIN LOCAL JT�ALTH �I)IS.TRICT r <br /> FOR OFFICE USE• 1601-E. Hazelton Ave. , Stockton., Calif. <br /> Telephone: (209) 466 -6781" <br /> PLIC+CATION FOR'>WELL':.CONSTRUCI"�ION OR PUMP PERMIT Permit No 7 73 I <br /> 4• <br /> THIS PERMIT- EXPIRES 1 YEAR FROM DATE ISSUED ; Date Issued g� ; <br /> 1 (Complete In Triplicate) <br /> Application is hereby made t6, the San. -Joaquin Local Health District for a permit to construct MTo- <br /> and/ox install the work herein described. This application is made in with San Joaquin <br /> County Ordinance No: 1862 and'-the Rules and Regulations of the San Joaquin Local Health District._ . i <br /> JOB ADDRESS/LOCATION Z, ,e Vi! CENSUS TRACT ' <br /> Y .. <br /> Owner's Name <br /> Address D + <br /> — --I��-r•.•-= <br />