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OFFICE USE: <br /> APPLICATION FOR SA <br /> NITATION PERMIT Permit No. . •__ ___ <br />--------=--------- <br /> (Complete in Duplicate) <br /> Date Issued ---- <br />---------------------31---- <br /> __.---,.----------------31--- _:_._.'_.-.---- --------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made-to_the_San-J.oaquin,Local.Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> --------------------•----------------•-••--------..-------------------------•----------- <br /> A <br /> JOS ADDRESS AND LOCATI N____�� _____. _____ _ .,�� • ----=- <br /> t 1 _ 1 <br /> Owner's Name-----�'/Y�C�- !� -----------------------•---------- U i -------------- Phone_..- <br /> Address ,, r i--------------------- - --------------- • `f -- <br /> ------------------- <br /> Contractor's Name o_ J =----------------------------------------- one <br /> Ph <br /> i.rat. <br /> Installation will serve: Residence �Apartrr4rit House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:.-/-- Number of bedrooms A_ Number of bathsrF'/-;-".Lot size -----=------------------------- <br /> Water Supply: Public,system [Community system ❑ Private ❑ Depth to Water Table ft <br /> Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑" Clay Loam [:] Clay C] Adobe�Flardpan E] <br /> Previous Application Made: (if yes,date__ --------_______ ) No11�New Construction:-'Yes E] No /'FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:; <br /> (No septic tank-or ces§p-col permitted-if public sewer is available within 200 feet.) <br /> Septic Tank:, Distance from nearest -----Distancefrom founndation---_ <br />