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79-687
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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24897
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4200/4300 - Liquid Waste/Water Well Permits
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79-687
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Last modified
6/27/2019 10:53:42 PM
Creation date
12/1/2017 9:59:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
79-687
STREET_NUMBER
24897
Direction
S
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
SITE_LOCATION
24897 S UNION RD
RECEIVED_DATE
08/03/1979
P_LOCATION
JOE R MANCEBO
Supplemental fields
FilePath
\MIGRATIONS\U\UNION\24897\79-687.PDF
QuestysFileName
79-687
QuestysRecordID
1963730
QuestysRecordType
12
Tags
EHD - Public
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Applications Will BeProcessed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> f (For Non-Transferable, Revocable, and Suspendable) , <br /> t SE PTAG E <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby made to car on business in the jurisdictional area of the San Joaquin L al Health District oxy <br /> CA Business N me (DBA) ` Address � �q� <br /> aOwner Address r Gt W fe <br /> Firm Partners, Addresses and Telephone Numbers <br /> CL <br /> Business Telephone No. Emergency Telephone No. 0'3M LG _ <br /> Contractor Licence No. <br /> LApplicants Name (Printf Title Dal�[nom Date <br /> Please check Applicable Category (1-7) and Fill in the Required Information <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, - June 30, 19 Disposal Sites <br /> Description(Make/Yr., Color) <br /> Serial No. CAL. License No. CAL. Licc.se Renewal No. <br /> Capacity Gal., Weights & Measures No. <br /> Equipment Parking Address v J <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 (� <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. <br /> Test Location Test Date/Time <br /> 0,32r SANITATION PERMIT <br /> Job Address/ ocation '�/ 7 S R �Q C Q_ a <br /> Owner b, te- a E-V1 o Address <br /> SEPTIC TANK ❑ CESSPOOLLEACHING FIELD C1SEEPAGE PIT ElPACKAGE PLANT <br /> PERMANENT ❑ TEMPORARY r %NEW ❑_REPAIR ❑ OTHER <br /> 5. ❑ CHEMICAL TOILETS For July 1, itiJune 30, 19 <br /> Type Construction 1 Disposal Site <br /> No. of Units Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1,�-June 30, 19 <br /> Operator Name Where Certified <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 , <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state lawA, and rules and ulations of the San . aquin Local Health District. <br /> APPLICANT'S SIGNATURE <br /> q <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1.&Received By January 31 ❑ July 1 8,Received By July 31 <br /> BILLINGEMI $ REMIT <br /> BASE - EXPLANATION ! AMOUNT DUE CHECKED <br /> DATE AT REMITTED AMOUNT <br /> FEE Z 3 <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY - <br /> OTHER <br /> OTHER <br /> -79- �� ? 7 <br /> Receive by I Da Receipt No. Permit No. Isso5ance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: 'ENV1ROMMENTAL HEALTH PERMIT/SERVICES `-1601 E.HAZELTON.AVE.,P.O.Box 2009 STOCKTON,CA 95201 <br />
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