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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .......-... No. <br /> ............... ...... � ... <br /> (Complete in Triplicate) Permit <br /> ........................... <br /> I` r"cJ Date Issued <br /> I, This'peM it-Expires 1-Year-From Date lssued <br /> i <br /> Application is hereby mad. to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described, This application"'is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> P <br /> JOB ADDRESS/LOCATION(: ........ ......... Q.ct- !J ............... .....CENSUS TRACT .................:...::... <br /> Owner's Name .......... l r­­............ •---•..............Phone ....6a.�/a7- ..... <br /> a <br /> � ..-.. . ...--• --- - ---- .. . . .arra, <br /> ter; SAA - •-------------------- <br /> q�.?./d ...lw_...� (. Cit <br /> Address ... ---• y ............. --------------------- ............................. <br /> Confr ctvt"'s:Name I' <br /> ..... ....License #� .'3Y_3... Phone <br /> ` U <br /> ......... ._ <br /> + Installation ill serve: Residence �A�rfn`enyt House C] Commercial []Trailer Court C] <br /> i 'Motel ❑Other ........ _ ...--------••-------- <br /> Number of living units:....i��'l Nu�ber of bedrooms ----3..._Gaibage'Grinder ...._. _.. Lot Size -. -.. '�. .....------••...� <br /> d <br /> Water Supply: Public Syste ''d d ame _...._..... - - '�� --.....Private ❑ <br /> ----•.............. .....__.----- - � d <br /> Character of soil to a depth�of-3/41..-, Sand`❑ Silt❑ Clay ❑ Peat[,] Sandy Loam ClnyiLoamX <br /> ' <br /> H-cirdpan [❑ Adobe ❑. i .I1`M6te ;a1.........:. If yes,type .... -c......-. , <br /> location <br /> of m in relation to wells�buildin s etc. must l; <br />