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78-302
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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THELMA
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4200/4300 - Liquid Waste/Water Well Permits
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78-302
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Entry Properties
Last modified
6/9/2019 10:15:04 PM
Creation date
12/2/2017 12:42:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
78-302
STREET_NUMBER
244
Direction
S
STREET_NAME
THELMA
STREET_TYPE
AVE
City
STOCKTON
SITE_LOCATION
244 S THELMA AVE
RECEIVED_DATE
5/5/1978
P_LOCATION
BOB LINDSEY
Supplemental fields
FilePath
\MIGRATIONS\T\THELMA\244\78-302.PDF
QuestysFileName
78-302
QuestysRecordID
1944243
QuestysRecordType
12
Tags
EHD - Public
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FOR OFFICE USE: FOR OFFICE USI: <br /> APPLICATION FOR SANITATION PERMIT 7� 3 O Z <br /> (Complete in Triplicate) Permit No................. <br /> Date Issued.....-............ <br /> ....................... ......... ................ ... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION... . _ .� <br /> --------..CENSUS TRACT--------------- - --------- - <br /> Owner's Name.... ... Phone...... <br /> Address. ..-- -. �1. Cit <br /> Y . .---------- --........ . .....License #,30y_//Z7.__ -PFone..Contractor's Name...... . <br /> � . <br /> Installation will serve: Residence N Apartment Flo se ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ . Other- ---- - - ------------ _ y <br /> Number of living units;....._.__ _ _.. <br /> Number of bedrooms. . . Garbage ... <br /> age Grinder... .-____Lot Size-----l,..d /1..� 1 ................. .... .. <br /> Water Supply: Public System and name.. ........I _-------------------------------------------............................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam [3� <br /> Hardpan ❑ Adobe ❑ Fill Material - if yes, type-------------------------------- �} <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> Size ... Pth. - • -----_._._Li uid D - -�- - <br /> Capacity_---rC. ld---TYpe---- --....._._._ aterial_. ,C ._..._...._No. Compartments---' ------ ------ <br /> Distance to nearest. Well------- .. Foundation____40.......... .. Prop. Line---- --------------- - <br /> LEACHING LINE [ ] No. of Lines .......................... Length of each line_..--.-----------•-•----- -- Total Length .. ..-------------..-----.---..---•-. <br /> 'D' Box..../.....Type Filter Material--- Depth p �! <br /> .. Filter Material. --_��- - -- ---- ----------------------------- <br /> Distance to nearest: Well___.PAC-4. Foundation.------------------------...Property Line..____._.__..___.._...........- <br /> SEEPAGE PIT [ ] Depth.. Diameter.._- .-3__ __ Number- .............. Rock Filled Yes No <br /> Water Table Depth---------------------------------------------------------Rock Size------ �(--------------------------- <br /> Distance to nearest: Well..-..L.-19.0..........................Foundation._..r .UQ...-. - ....Prop. Line----`d.._._..._....------ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.................. -------- ----------------Date._______-___--_..............................) <br /> Septic Tank (Specify Requirements]_--- - ----------------- --------•• ..-.----- ------------ <br /> Disposal Field {Specify Requirements).................... . ..._._..._ .............. <br /> --------- <br /> ----------------- ---------------- -------------- .......................... --------------------------- -------- - - .................. ------------ --------- <br /> {Draw existing and required addition on reverse side] <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed.-....................... -- ---------•----- Owner <br /> BY / Q f' A .. ------- .... Title------------- ------------- <br /> (If other than owner) <br /> FORD PART ENT USE ONLY <br /> APPLICATION ACCEPTED BY- r ... DATE ___51- 5- 1_74............ ....... <br /> DIVISION OF LAND NUMBER-_--------- --..... ,..... . .... .... DATE.-...... ......... --------- <br /> ADDITIONAL COMMENTS.... x.....33ZS < �-----�----��------------- ---------- <br /> -- ------------ ----- ----------- - ---- -- ------------------------------ ----------------- --------------------------------------•--•---- - _.......... -----•--.--.... ---- .._ ..... <br /> ------------- -------------- ------------ ---- -•----• -------- ---------------- ---------_........-.. <br /> --------------------------- . <br /> ............ .... . <br /> Final Inspection by. I -- . . - pate._... <br /> - - -------- <br /> FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT ra.s 21677 3M <br />
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