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FOR OFFICE USE: t .......... APPLICATION FOR SANITATION,PERMIT .................. 1Compleh in Triplicate) Permit No.-7s�.: .. This Permit Expires 1 Year From Doh Issued Date Issued/ _.:. �:�5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work her sin described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations- JOB 13 S . Sinc hair JOB ADDRESS/LOCATION ...................... ...,•............................. ....... ..---..........CENSUS TRACT .... ........ .......................... Owner's Name Mr .. Arnold Schweitzer . P ....------ -••-•••-•--••..................•••-•--.....-- hone Address ..... 67-- S. Sinclair City kton ...........................•-----....----• 2 1 ........_ ....... - Contractor's Name -__.....---Roto_--Rooter--Sewer__-S r. License # Z7.153.9........ Phone .. 6 -. 67 6..••.._ Installation will serve: Residence 0 Apartment Houser Commercial oTraller Court I-] I Motel p Other................................... r Number of living units:------1_-. Number of bedrooms --- -------Garbage Grinder A2....... Lot Size ....50..b ...100....... _. Calif. Water Ser: 3` Water Supply. Public System and name.___. :.._Private [] .......... ........._....-•............................... Character of soil to a depth of 3 feet: Sand ] Silt[) Cloy 0 Peat 0 Sandy Loam 0 Clay Loam [I Hardpan 0 Adobes Fill Material ............ if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to'wells, buildings; etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,)' PACKAGE TREATMENT [ 3 SEPTIC TANK{ ] Size......:.............. ...... Liquid Depth .... Capacity ..................... Type •----- •-•... ------ Material..------------. ----•- No. Compartments ..................... Distance to nearest: Well .._Foundation ..._.............:..... Prop. Line W LEACHING LINE [ j No. of Lines ------------------------ Length of.each line............................ Total Length 'D' Box Type Filter Material ....................Depth .Filter Material ....--............ .......... ....._.• , Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ r SEEPAGE PIT ! ( 1 Depth .-....: Diameter Number . ---•,—,.,,,,,_„ - ---------------- ............... Rock Filled Yes [] Water Table Depth ....... ..................... ..............Rock Size ................................ l Distance to nearest: Well -----------------------------=..........Foundation ----........ ....... Prop. Line .... .................F REPAIR/ADDITION(Prev. Sanitation Permit# ......................... Date•._.:..::....::-•--:.. Septic Tank (Specify Requirements).------....:....&dd---appz.,... Q._.fe;e .--off' leach and 1 - e+ b 2 t it Disposal Field (Specify Requirements) ..............�0 existing system ------------------- -- ------------------...--------------- _........ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thatr 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. Homs owner or IiCen- sed agents signature certifies the following: I "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner Y as to become subject to Workman's Compensation laws of California." . r Signed ---------------- - --------------- Owner -- ---- - -- ----------•---•------------------•------ BY ------------------------ Title -Gora.tra,ct.or------ (I oth than owner) FOR 09PARTMENT USE ONLY APPLICATION ACCEPTED BY DATE�'.."' _'7i F - .---- --- •-- BUILDING PERMIT ISSUED ............ ••--- . - ------------------ -------.-DATE ..------------------------._-. ADDITIONAL COMMENTS --_.................................. . .. •--••------ -- - ------ ------ -•---•--- •-•----•-- ......................••-------------•---------•-.. .---------------------------------------------------------------------- -- ---------- ---- - - -----•- ----- ^_ --------------------------•---•----•--.........--------••- -- Final Enspection by: Date ... .--"'. � .... ..... .... --.... .......... ................. EH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M