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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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T
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12 (STATE ROUTE 12)
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13889
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3500 - Local Oversight Program
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PR0545719
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Last modified
11/19/2024 3:47:34 PM
Creation date
6/3/2020 11:21:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545719
PE
3528
FACILITY_ID
FA0005335
FACILITY_NAME
CHARLES JACOBS
STREET_NUMBER
13889
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
13889 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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LSauers
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EHD - Public
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•� � � UNIT IV <br /> WELL RMIT APPLICATION M <br /> kR4 <br /> J., <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 <br /> E (209) 468-3449 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with <br /> San Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Public Health Services,EnvironmentalAssessor's <br /> Health Division. <br /> 2 [� C I Cross Street&6jG CeGIC City LoJ f Z+p�ParceI <br /> WELL Location I J0 _w � +� !S •��`-� C <br /> r{ / QQ _ _CityS Zip�o?Phone# 7� <br /> PROPERTY Owner S Address <br /> + C-57 Contractor. <br /> IJP — 7Ma _Address 8 City �uot 0 Zipiau Lic#�`�Phone# lq 'g�j t; <br />
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