My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
REMOVAL_1986
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
M
>
MOFFAT
>
812
>
2300 - Underground Storage Tank Program
>
PR0504316
>
REMOVAL_1986
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/4/2024 11:19:42 AM
Creation date
11/7/2018 7:45:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1986
RECORD_ID
PR0504316
PE
2381
FACILITY_ID
FA0006163
FACILITY_NAME
RAYMOND, W V
STREET_NUMBER
812
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
812 MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MOFFAT\812\PR0504316\REMOVAL 1986 .PDF
QuestysFileName
REMOVAL 1986
QuestysRecordDate
10/16/2017 10:04:26 PM
QuestysRecordID
3683473
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
22
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
Appmetions WIII Be p�seed When Submitted Properly Completed.Be Soo Sign The Application. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT GENERAL <br /> IF VEHICLE INVOLVED, GIVE <br /> ENGINEER'S AND/OR APPLICATION Make -- <br /> APPLICANTS AND/OR <br /> CONTRACTOR AND/OR ENVIRONMENTAL HEALTH PERMIT/SERVICE Lid.No. <br /> BROKER AND/OR FOOD ESTABLISHMENTS,HOUSING Regist.No.� <br /> LICENSE AND/OR PUBLIC POOLS,MATER SAMPLING Color <br /> REGISTRATION REAL ESTATE INSPECTIONS <br /> NUMBER POULTRY RANCHES AND KENNELS <br /> MISCELLANEOUS SERVICES v10G <br /> rApplication Data Z3 ,g Business/Name To Appear On Permit /. <br /> G aoAd .4 po <br /> ,Type Permit/Servic,¢Reqquuested: ress dO d <br /> Applicant Name iii/��v t4f �o N-!l <br /> A <br /> B sines Tale It ne No. � -2 2 Emergency Telephone No. <br /> 7; <br /> Property <br /> Property Location/dress <br /> Property Owner S/D ri .ei4yN�OND Address <br /> Address <br /> L Operator's Name <br /> ge Restaurant, <br /> 1. FOOD ESTABLISHMENTS Total Building Sq.footaALE Maximum Seating Capacity <br /> SALE <br /> 0 RESTAURANT 13 FOOD MARKET RETAIL ❑ FOOD MARKET WHOLE11 MEAT MARKET <br /> ❑ COMMISSARY 13 ICE PLANT ❑ BAKERY <br /> [3 FOOD PROCESSING PLANT ❑ ITINERANT RESTAURANT <br /> [3ROADSIDE FOOD STAND 13 LIQUOR BAR LIQUOR STORE 13FOOD VENDOR <br /> ❑ CONFECTIONARY STORE 13 FOOD SALVAGER 11 FOOD DEMONSTRATION <br /> ❑ VENDING MACHINES/No.of <br /> ❑ MOBILE FOOD PREP.UNIT ❑ VENDING VEHICLE <br /> ❑ FOOD CROP HARVESTING/No.of Field Employees <br /> ALL APPLICANTS: Total Employees Including Operators <br /> 2 HOUSING ❑ CERTIFICATE OF OCCUPANCY <br /> ❑ HOTEVMOTEL/No.of Units <br /> ❑ MOBILE HOME PARK/No.of Spaces . . ❑ CHEMICAL <br /> 3. WATER QUALITY ❑ WATER SAMPLE(Bacterial) <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER _ <br /> NO.OF PUBLIC SERVED(Connections) <br /> 4, RECREATIONAL HEALTH ❑ SWIMMING POOL 13 SPA <br /> ❑ WADING POOL ❑ NATURAL BATHING PLACE <br /> S. VECTOR CONTROL ❑ POULTRY FARM/Maximum No.of Birds Na o1 Confining Cages <br /> E3KENNELJRunways /Animal Population No. <br /> Sewage Disposal Method _ <br /> Solid Waste Disoosal Method <br /> Water Supply Source Animal Waste Disposal Method <br /> y 13 BUSINESS LICENSE <br /> 6. (p(CONSULTATIQM FEF97( 13 DANCE PERMIT <br /> 7. pIPLAN CHECKING FEE <br /> a. REAL ESTATE <br /> REQUEST: Water Well Inspection E3 Sample❑ Title Company Tele.No. <br /> Sewage System Inspection 13 Address <br /> Escrow No. <br /> Seller Seller Address <br /> Telephone No. Seller Agent Name <br /> Service Request For Date <br /> I hereby certify that 1 have ared this application and that the work will be done in accordance with Sen Joaquin County <br /> ordinances,state laws,a rul and gula ons of Ke Joaquin Local Health District. <br /> APPLICANTS SIGNATURE X <br /> Title !��- Date S 23--'- <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE 13 EACH ❑ January 1 A R—i—I BY January 31 ❑ July 1 A Received ByJuly 31 <br /> REMIT <br /> REMITTANCE S AMOUNT DUE CHECKED <br /> BASE EXPLANATION BILLING <br /> Q DATE DATE REM�1ITTED AMOUNT <br /> FEELESS <br /> 7O KV•UO <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> uno s Z7-scL t <br /> .� by Dete Receipt No. Pa t NO. In Gate Me led Delivered i <br /> APPLICAMT—RETUaN•r, CCMESTO: ENVIRONMENTAL HEALTH PERMRBERwCEE ta01 E 11AZELTON AVE.P.O.aea IDOS STOCRTW4 GfS7a1 <br /> w <br />
The URL can be used to link to this page
Your browser does not support the video tag.