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APPLICATION FOR SANITATION PERMIT Permit No. ...3 __ LS7 (Complete in Duplicate) Date Issued Thi Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described, s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----2446 Me CoMba Avenue -- -----------------•-------------------•------------••------------------------------------------- Owner's Name------------- -----------------s�ACk Drager - -- -- ------------------ Phone------!!?93>+g---------•---- Address _______ Same" '". 0. K. Trailer Court - ---------------••---------•----------- ---------------------•---------••-------------- ---••------ Farrish Inc Contraci�or's Name----------------------------- • 9+y96o7 __ _____ - -------- - ---- � Phone-------•--•-----•---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other , 10 �rgil? s ❑ Number of living units: um er o edrooms ________ Number of baths -------- Lot size Wafer Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 'Hardpan ❑ r Previous .Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ Sewer line for trailer sanitary TYPE OF INSTALLATION AND SPECIFICATIONS: facilities. r/ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Plumbi4g Permit jo 3 issued I Septic Tank: Distance from nearest well_________________Distance from foundation--------_____---t Material EXi iY No. of compartments -.--Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well--------------.__Distance from foundation--------------------Distance to nearest lot line_______ Exilairlg Number of lines---.,------------------------------Length of each line-----------------------------.Width of trench----------------- --"-- sT --- ----. Type or filter material--------------------------Depth of filter material-----------------------Total length----------------------:_--- Seepage Pit: Distance to nearest well-----------------_----Distance from-foundation--------------_ ___.Distence to nearest lot line___"-._._______"_ ❑ Number of pits----------------------Lining material--------------------__.Size: Diameter------------------- Depth-------- --------------- esspool: Distance from nearest well-----------------Distance from foundation ,.-_Lining material-------------------------------- -- Size: Diameter Depth ---- ---------�----#---------------------Liquid Capacity q ------------------ --------gals Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building Distance to nearest lot line Remodeling and/or repairing describe :_____This application is for the la 1 y ng of approximately &O----lin_-ftof _4"__v_ frit ed aexer i -e ......0-11 ---------------------_ traps__.for receiving _.� _ � 5 trailer hose,-,__,,_2 cast iron clean outs; 1 4 vent 10 above the Bur ace, Thf s ri lx beiiii---int o---the eai s t frig s e tic tank------------------- ----------------------------------------------------------------- ------ ---------------------------------------------------------------------------------------------------p•---------------------- -------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------PJMISH INC, F --- - ------ --- - ---- -----------------------------------------------•-------------( Contractor) By:---------- an ractor) - -•--- -------------------(Title)----Estimator (Plot plan, showing size of lot, locaf' n of stem in relation to well ui ings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- --- --------------------- - = DATE_ REVIEWED BY----- --•----------------------------- �--A��-- ------------ -- - ------------- -- BUILDING PERMIT ISSUED ]. DATE_ ------- ------------------ ------•---------- - DATE_.-.-------- --------------------------------------------------- --------•------- ------------- A terafions and/or recommendations:--------- __.____. ---- - -----------------------•------------- FINAL INSPECTION BY:. . "___ "--"- -----. . Date_ ' � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stocic+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100