My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SU0004722 SSNL
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
L
>
LONE TREE
>
30400
>
2600 - Land Use Program
>
PA-0400693
>
SU0004722 SSNL
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/7/2020 11:31:09 AM
Creation date
9/6/2019 11:02:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0004722
PE
2631
FACILITY_NAME
PA-0400693
STREET_NUMBER
30400
Direction
E
STREET_NAME
LONE TREE
STREET_TYPE
RD
City
OAKDALE
Zip
95361
APN
22914011
ENTERED_DATE
11/24/2004 12:00:00 AM
SITE_LOCATION
30400 E LONE TREE RD
RECEIVED_DATE
11/23/2004 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\L\LONE TREE\30400\PA-0400693\SU0004722\SS STDY.PDF
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
66
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUbrISOUNTY ENVIRONMENTAL HEALTH`ePOPARTMENT <br /> SERVICE REQUEST <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> OWNER/OPERATOR <br /> CHECK If BILLING ADDRESS <br /> Mr- Rochard Green <br /> FACILITY NAME <br /> Green Property <br /> SITE ADDRESS 39324 E Lone Tree Road Oakdale 95361 <br /> �' �� Street Number I Dirt St,.et Nae DAY My Cotle <br /> HOME or MAILING ADDRESS (If Different from Site Atltlress) <br /> 3 /GU Street Number Street Name <br /> CITY //atdtlllL T TE <br /> PHONE#1 Exr. APN# LAND Lite APPLICATION III <br /> 12091 3qg- D1/0/ 1 229-140-11 C—PA-04-693 <br /> PHONE#2 Exr' BOS DISTRICT LOCATION CODE <br /> I 1 <br /> CONTRACTOR / SERVICE REQUESTOR <br /> REQUESTOR <br /> CHECK if BILLING ADDRESS <br /> Dave Wplrh <br /> BUSINESS NAME PHONE It En' <br /> HOME Or MAILING ADDRESS FAx# <br /> 902 Industrial Way I l 369-4228 <br /> CITY LodSTATE CA ZIP 95240 <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project <br /> or activity will be billed to me or my business as identified on this form. <br /> also certify that 1 have prepared this a 'cation ano that th rk to b fo ed will be done in accordance with all SAN JOAQUIN <br /> COUNTY Ordinance Codes,Stand, ,S TPt and DERA a S. <br /> APPLICANT'S SIGNATURE DATE:DATE: <br /> PROPERTY/BUSINESS OWNER LID OPERATOR/MANAGER If OTHER AUTHORtzEDAGENT O <br /> If APPLICANT is not the BILLING PARTY Proof of authorization to sign is required Title <br /> AUTHORIZATION TO RELEASE INFORMATION: When applicable, 1,the owner or operator of the property located at the <br /> above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment <br /> information t0 the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it IS <br /> provided to me or my representative. <br /> TYPEOF SERVICE REQUESTED: .Soli Suitability .Study Review <br /> COMMENTS: <br /> -Ap� /�'p '- 7 RECEIVED <br /> � br <br /> ,rcw ll,�vrvW APS 2 5 2005 <br /> ® B/W JOAQUIN COU <br /> APPROVED Eli. EMPLOYEE#: ApPA /5 s <br /> ASSIGNED I EMPLOYEE#: DATE: <br /> Date Service o pleted (if already complet d): SE ICE CODE: _ P/E: � <br /> Fee Amount: 7Amount Paid - - r Payment Date <br /> Payment Type ✓ Invoice# Check# r C�._ Received By: , <br /> EHD 48-01-025 SERVICE REQUEST FORM <br /> REVISED 6-5-02 <br />
The URL can be used to link to this page
Your browser does not support the video tag.