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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FOL OFFICE USE: 1601. E. Hazelton Ave. , Stockton, Calif. <br /> Telephone: (209) 466--6781. <br /> - APPLICATION FOR WELL CONSTRUCTION OR PUMP PERMIT Permit No. _,7 <br /> THIS PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Date Issued <br /> (Complete In Triplicate) E, <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> and/or install the work herein described. ' This application is made in compliance with San Joaquin <br /> County Ordinance No. 1862 and the Rules and Regulations of the San Joaquin Local. Health District. <br /> .TOB ADDRESS/LOCATION , CENSUS TRACT <br /> Owner's Name ( /� + y Phone , � ,0. <br /> Cp <br /> Address City <br /> t -P `".'V <br /> Contractor's Name License # Phone <br /> �—$ <br />