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I FOR OFFICE USE. . - APPLICATION--FOR-SAN ITATION-PERMIT F_ - :.L :_ W `" 69-698 ----- -------- Permit Na. ` (Complete in Triplicate) ---_ ------- ------------------------------------------------- --------------------------------------------------------- This Permit Expires 1 Year from Date Issued Date Issued ...8-20-69._. Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No- 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....1950 Cherokee Rd.,--APostaZac--Elem.---Sch_o__o1---------_-CENSUS TRACT -----17 Owner's Name Flame __Firat__P_entecasta1__Chiar.ch-------------------------------------------------------------------------Phone _462--4793----------- Address --- 1950- Cherokee Rd..x---------------------------------------------------------- City -----St_o__ckton,---Calif----------------- --------- ' Contractor's Name -----owner----------------------------------------------------------------------License # ------r . -_ Phone ------------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court i❑ Motel ❑ OtherClassroom Bldg. ----------------------------------- r Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ tot Size ___-_________________._______._._____--___ ' Water Supply: Public System and name ....Calif. Water ServiceCo_______________________________._.______------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ 'Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe [X-] 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.) s NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-[ Size--- L __X__5__ll_2__ _20_---_ Liquid Depth _--__ ._112t___._ i Capacity -24.00----------- Type -precast--- Material__OQnc-.-------- No. Compartments ----2---------------- Distance ------- - :_Distance to nearest: Well over 100. ...........Foundation _.____1�t_____.__ Prop. Line ------5 -------------- LEACHING LINE [ No. of Lines 2----------------------- Length of each line---__100-.........------ Total Length _200}------------------ Q 'D' Box ---__X---- Type Filter Material Septic__Ro_(IJ&pth Filter Material J9-'-1 i Distance to nearest: Well _oyer_ 100'--,_ Foundation ---U-------_- ---- Property Line, ----5----------------- SEEPAGE PIT {g] Depth ---2-._._________ Diameter ---33......... Number ------2-------------------- Rock Filled Yes 13 No 0 4 Water Table Depth __ 60� ____Rock Size ---- ( Distance to nearest: Well -------150--------------------------Foundation _].Q'- Prop. Line ..-•--5_'.._.--•---•- REPAIR/ADDITION(Prev. Sanitation Permit# --------------- ------ Date ----------------------------------) SepticTank (Specify Requirements) --------------------------------------- ----------------------------------------------------------------------------------------------------••- DisposalField (Specify Requirements) ------ --- ------------------------------------------------------------------------------------------------•--------------- ( --------------------------- ------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------------------ - - I -------------------------------------------------------------------------------------------------------- {Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shat) not employ any psrsen. in such manner as to become subject to Workm n's Compensation laws of California." E Signed (' ( ---- - ----------------------------------------- Owner By -------------------------------- f - - -- ---------------------------------------- Title ---------------- ------------------------------------------------------- (if other Allan er) MENT USE ONLY APPLICATION ACCEPTED BY DATE P'----�'-�------------- ! / BUILDING PERMIT ISSUED ----------- ---.--DATE ------------------------------------------- ADDITIONAL COMMENTS _This. _ s- a :_ ' t __ _e _ anly__the__l.s_t:4-_ciassxQgTns___&_-cantingelat-_tpilets--- r�ith._a__Iota-1 _ot-_100,_pe_ ons.--_s-:per_-_a_tta__ _ed letter. Future -require connection z ._to___a__treatment--Plant-_Q-&_ --- ] sewe_r_.__Permit- valid-_only-_-if. -sy_st_em--located_-on--single parcel- ' of record or on eas e rd. Plot pYan & layout by Albert Sangiannetti, Eng. ,___attacfied. -- - -------------- Final Inspection by: .... _-----------Date ._�___--� r ---------- N JO[A^QUIN LOCAL HEALTH DISTRICT E. �I � /._s�=ij� / i� _ .3' X S�+ ► 4J l'�J'G1�! ��G9� r'l/ "� �'Cr•EL- Q her® p e E. H. 9 1-'68 R v. 5M. /°