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Applications Will Be Processed When Submitted Properly Completed.'Be Sure To Sign The Application. k <br /> APPLICATION lv <br /> (For Non-Transferable,Revocable,and Suspendable) , , SEPTAGE' - <br /> 1 ENVIRONMENTAL HEALTH PERMIT <br /> I'1 LIQUID WASTE , <br /> Application i hereby made to carry on business in the jurisdictional area of the San Joaquin Loc I Health District <br /> r BusinessN BA) tc Of 10 <br /> ."Idillf, � Address � / ♦�} , <br /> Address <br /> z Owner ' <br /> .9 <br /> i Firm Partners, Addresses and Tel ne Numbers <br /> aBusiness Telephone_ No. Emergency Telephone No. <br /> 1 Contractor Licence No. <br /> Applicants Name (Print) Title Date _�\ <br /> Please check Applicable Category (1-7) and Fill in the Required Information CLARENCE'S SEPTIC & SEWER SERVICE �?V <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) 263 Sa. Oro StDCkton, Calif. 05205 r <br /> For July 1, June 30, 19 _ Disposal Sites ,,t, „Y -,;rr?rt^,•'c t-;r. <br /> Description(Make/Yr.,Color) <br /> CAL. License No. CAL. License Renewal No. Q <br /> Serial_No. - <br /> Capacity Gal.,Weights &Measures No. <br /> Equipment Parking,Address <br /> t, 2. ❑ PUMPER YARD f" <br /> For July 1, - June 30, 19 <br /> C' <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or-R: <br />