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(.(.9 `' .APPLICATION FOR SANITATION PERMIT � Permit No.ot_'� ------- <br /> y ICompldfe,in Duplicate) <br /> Rate Issued iV2---21/- <br /> Application is hereby made to the.San Joaquin Local Health District for a permit to construct and insta'llthe work herein described. <br /> This application is made in compliance with County Or nce No.. 5�4(9j. <br /> 7 `"'� --------------------------------------------------------------------'0. <br /> JOB ADDRESS LOCAT ON-._- .--•--- ------------- <br /> > <br /> Owner's Name--- -------------- • -------------- ------ - - �----= ----------------------- -------------------------- ---------------------------- Phone-- ------------�-- - <br /> �] r <br /> Address - ---------------------------------------_----------------=----------- <br /> -- ... <br /> Contractor's Name-------------•------------- --- - -- ------------------------------------------------------------------------------- Phone---------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M&el ❑ Other] / <br /> I l 1 ------ <br />