My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SR0084790_SSCRPT
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
W
>
WOODBRIDGE
>
403
>
2600 - Land Use Program
>
SR0084790_SSCRPT
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/4/2022 9:27:15 AM
Creation date
3/4/2022 9:12:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SR0084790
PE
2603
STREET_NUMBER
403
Direction
W
STREET_NAME
WOODBRIDGE
STREET_TYPE
RD
City
WOODBRIDGE
Zip
95258
APN
01502056
ENTERED_DATE
1/28/2022 12:00:00 AM
SITE_LOCATION
403 W WOODBRIDGE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
122
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 JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> Agricultural !(Z'00 <br /> /( OD � O <br /> OWNER/OPERATOR �— (/ <br /> Redeeming Way LLC c/o Jim Ehlers CHECK if BILLING ADDRESS❑ <br /> FACILITY NAME <br /> SITE ADDRESS 403 W Woodbridge Road nodi 95258 <br /> Street Number Direction Street Name city Zip Code <br /> HOME or MAILING ADDRESS (If Different from Site Address) PO Box 895 <br /> Street Number Street Name <br /> CITY Woodbridge STATE CA ZIP 95258 <br /> PHONE#1 EXT. APN# LAND USE APPLICATION# <br /> ( 209 )481-5770 015-020-56 <br /> L4-aOW2[3 ( Sw) <br /> PHONE#2 EXT. BOS DISTRICT LOCATION CODE <br /> ( ) q ] <br /> CONTRACTOR / SERVICE REQUESTOR <br /> REQUESTOR Cecil Dillon CHECK if BILLING ADDRESS 0 <br /> BUSINESS NAME Dillon & Murphy Engineering PHONE# EXT. <br /> 209 334-6613 <br /> HOME or MAILING ADDRESS PO Box 2180 Fax# <br /> CITY Lodi STATE CA ZIP 95241 <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 /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUtN <br /> COUNTY Ordinance Codes,Standards,STATE and F E la s. <br /> APPLICANT'S SIGNATURE: DATE: I ZZ <br /> PROPERTY/BUSINESS OWNER❑ OPERATOR/MANAGER ❑ OTHER AUTHORIZED AGENT® oject Lgineer <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 to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is <br /> provided tomeoorrsmy�representative. <br /> TYPE OF SEf�fAXIMUT J T,Q <br /> COMMENTS: RECEIVED <br /> JAN 2 8 2022 J V/ <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEP TM <br /> ACCEPTED BY: EMPLOYEE#: DATE: IIID <br /> ASSIGNED TO: EMPLOYEE#: DATE: <br /> Date Service Completed (if already co pleted): SERVICE CODE: PIE: 6 <br /> Fee Amount: J� Amount Paid [� Payment Date / 2� <br /> Payment Type Invoice# Check# 22 S Receiv d By: <br /> EHD 48-02-025 SR FORM(Golden Rod) <br /> REVISED 11/17/2003 <br />
The URL can be used to link to this page
Your browser does not support the video tag.