Laserfiche WebLink
SAN JUAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, STOCKTON, CA 95201-0388 <br /> PUBLIC WATER SUPPLY PERMIT APPLICATION <br /> Application Prom Frf.-)c�� ��► �_ �- �v, /-�" r 4 <br /> r (NAME OF UTILITY) <br /> Applicant JCC C V'errJ"4.M f- <br /> (ENTER THE NAME OF THE LEGAL OWNER, PERSON(S) OR ORGANIZATION) <br /> Address 31 � ff-t rt c- + ctr=q �' �+f tEc Cx_57 <br /> (ADDRESS OF LEGAL OWNER, PERSON(S) OR ORGANIZATION} <br /> To San Joaquin County Public Health Services, Environmental Health Division: <br /> Pursuant & subject to the requirements of Division 5, Part 1, Chapter 7, California Safe <br /> Drinking Water Act of the California Health & Safety Code (CHSC) relating to domestic <br /> water supplies, application is hereby made for a permit to <br /> O a- .�. �, 411 <br /> (Applicant must state specificaliy what is being applied for-whether to operate a water system,to construct <br /> new works,to use existing works,to make alterations or additions in worms or sources. Note Section 4012, <br /> CHSC,requires detailed plans and specifications to accompany all applications to construct or modify a public <br /> water systern(s). <br /> Dated 3/A� <br /> I (we) declare under penalty or perjury that the statements on this application & on the <br /> accompanying attachments are correct to my (our) knowledge & that I (we) are acting <br /> under authority & direction of the responsible legal entity under whose name this <br /> application is made. <br /> By 1')C' � t-GG/( <br /> Title �t ,e i+i/e, �r+ <br /> Address 3'10 6tmg, 4W, A1nfe,�z-, el,* 533 <br /> Phone (day)j? 7) X93 - 95937- Phone (evening) 72 y� <br /> 5194 <br />