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SR0084725_SSNL
Environmental Health - Public
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EHD Program Facility Records by Street Name
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FOREST LAKE
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3067
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2600 - Land Use Program
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SR0084725_SSNL
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Entry Properties
Last modified
2/10/2022 9:25:54 AM
Creation date
2/9/2022 10:52:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SR0084725
PE
2602
STREET_NUMBER
3067
Direction
E
STREET_NAME
FOREST LAKE
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00537002
ENTERED_DATE
1/13/2022 12:00:00 AM
SITE_LOCATION
3067 E FOREST LAKE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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FOR GfFl<E usE APPLICATION FOR SANITATION PERMIT <br />LCemPlenn THplmNI Permit Ni L1_� <br />..ThlsPermtBapirnIYearFemDolel..aed o.levand. G/Z,/ <br />Application washay made to the Son Joaquin Local Health m cr for a G 1 ro construct and Psi IM work herein <br />mormbetl This ppl ion ie d pl ante with County Ord'naue N 5499 and existing False and Regvloobp m <br />JOB ADDREBB/LOCATION A. f -ex sol vQtS' /YC.•-CEInJ5U5 TRACT rr'✓/ <br />.. <br />Oxner's Name I -TD.h W e�y'/11i/C)y ...... %cone. <br />_............. ........ <br />Address Sfi'/zare _. ._..... ...... .City _.... ... <br />Contractor s Nome .. Xede^'e _. _lornseis...._. Phone ._...____.._ <br />Installation will wove. R EcomApartment Haute[] Omar " I Mraller Court <br />Motel Otho <br />Numbm of 1Nfing r [... Number of bedroom, 3 Gwi mge Grantor ° Lot Siu _._.. <br />Water Supply Note Sy,mm and name e Povar <br />Character of trot he a diIthofSftN Sorel Ll BIt❑ Cloy MrUfAmI Sade Lo._mm llClay Loamg ilk <br />... IIi�+—`V — ,r <br />Hmdpon❑ Ad 6 p fill Meterbl If wI type <br />Plot plan, showing size of tats location of system in relation mwdlybuil <br />NEW INSTALLATION: !No septa mnk or mandate pit pe Tred If Fr i or, <br />PACKAGE TREATMENT I ] SEPTIC TANK Slee '05N14X e <br />macerate /.?TOO TYPe F",r IODILOPublit G <br />Distance to nearest Well sib' hu <br />LEACHING LINE X No. 05Lines ._... Length of each Iln .... <br />'D Boz Type Filer M m I J?a'rt� D E <br />DI,Mnm To named Well _.ib mrni n <br />SEEPAGE PIT [A APath odi Immo .33_Har <br />Ail Water Table Depth/� JAM <br />Damn ef Well _. /4t! _l,sm, <br />M nre <br />eo <br />REBAIK/ADOmONIPrev.Sanimran Permlf ____.._..___.____.._.Date <br />Sepia Took (Specify Requirements] <br />Disposal Field I31 Requirements) ___.. _. ........ <br />mars be placed on reverse Aide.l a <br />,liable within 200 fee,) y <br />P <br />A <br />' Liquid Depth <br />/NO. mu P mmems, <br />�froffLm - <br />W <br />. Taal Longth.aa `- <br />Mmerml /F .._.. .... <br />_. promemy LimS..._ <br />Rask N11,d Yn]R^ No a <br />Pace, Line ._.5....._r� <br />I Fertbr reify IFn 1 booim, mod At, epplimi and that the work wilklm done in momil wilh San J quln <br />Counts Ordinances, SMre Laws, ed Rule, and! Regulaxnm of the Son Ioaquin iemlime ig Dlsldel. Nome Peru oa Ilan <br />• Ran rlBn the following: <br />b, M h er <br />P dma f F k imwM Phil Isiu MII *;4141,Y P each rA menmr <br />or m Br UP Workman., G pemelianhopes <br />1California." <br />Sg td App yy 4 _ Owned I <br />By-, <br />aT <br />J Il otr <br />ter ..... _Yale_ .... L... ............. <br />pM1 rrhan ow ) ` <br />w rvT USE 01i <br />BULLDINGIGN ACC PTEDI BY 4{.� _. DATE <br />ADDITIONAL COMMEMs .... � .R� "Y •DATE - <br />111. 1 S4 <br />Fnal ]nap en by ZL��+•�-( , _ 'cars / 711�.. <br />L PAN JOAQUIN LOCAL HEALTH DISTRICT <br />q" <br />c E. H.9 1 68 By, 5M <br />
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