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FOR OFFICE USE: APPLICATION-FOR SANITATION PVRMIT <br /> ------- -------------- ------ --------------------------- i Permit No. <br /> {Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is Hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is m de ' mpliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> VEre,_ <br /> ----CENSUS TRACT _S__ -�------ <br /> JOB ADDRESS/LOCATIION_Owner's Name Lam.------•-=�4""" dx✓---------------- -- ----------------------- - - ------------------- - ---Phone ------------------------------ <br /> Address <br /> ----- -- --------••--------Address --------- � �_1=nc- 44%4c2 a,401`--------------------------:. City r -------------------------------------------------- ! <br /> Contractor's Name _._. --------------------- --- ----- -.License # ---------:-------------- Phone ------ ---------------------- <br /> Installation will serve. Residence=_ 'parfiment=HouserCommercial-❑Trailer:Court ;]; <br /> 'Motel Other ----- --5 ----------- <br /> Number <br /> --- ----Number of living units:_______I__ Number of bedrooms -__ <br />