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C FOR OFFICE USE: <br /> IPPLICATION FOR SANITATION PER` <br /> --------------------------------------------------------- � �!, ,! Permit Na. -(f1---'--,------- <br /> IComplete in-Triplicate) <br /> --------=-------------------------------------------• Q' a�J� <br /> (j <br /> • __ _ ______________________ This Permit Expires i Year From Date Issued Date Issued __`--_______--`---1 . <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ql:� 3 AJ -&.j <br /> 108 ADDRESS/LOCATION ._ d - --- --- RT.__ �^- --- :----------_CENSUS TRACT ---------------------�--- <br /> Owner's Name ------ /UI Q------ -- -�1� ----•------------------------------------ —---- ---------- hone --------------------------- -------- <br /> Address --- ----- - --------- --- -- ------- --------- -------------------------------------------------- <br /> License <br /> ------------------------------- ---------. - <br /> ------------- - ------ - ------ <br /> City . <br /> Contractor's Name _____- --__ --- <br /> I <br /> - License # I Phone ___________________ <br /> --------- <br /> Installation will serve: Residence j7IApartment House Commercial.❑Trailer.Court <br /> Motel ❑Other------------=------------------------------- <br /> - <br />