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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Nan-Transferable,Revocable, and Suspendable) SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUI10 WASTE- <br /> Application is hereby made to carry on business-in"the jurisdictional area of.the San Joaquin Local Health District <br /> Business Name (DBA) <br /> World Enterprises Address P.O. Bax 8598 Stockton, Ca. 95208 <br /> z Owner r'i> Hathcoat Address P.O. Bax 1151 '�Lafa ette Ca. 94549 <br /> a <br /> 1 Firm Partners, Addresses and Telephone Numbers <br /> A. <br /> Business Telephone No. 466-0710 Emergency Telephone No. - <br /> Contractor Licence No. 265964 <br /> a Barbara Lawler+ Title Bookkeeper . , Date 5/20/81 <br /> Applicants Name (Print) <br /> Please check Applicable Category(1-7)and Fill in the Required Information .,, ri�1 <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) 01 <br /> For July 1, June 30, 19 Disposal Sites: �n <br /> Description(Make/Yr., Color) <br /> Serial No. CAL. License No. CAL. License Renewal No. <br /> Capacity Gal., Weights & Measures No, <br /> Equipment Parking Address _ <br /> 2. ❑ PUMPER YARD . tir rte• �-� w'+ . ., "' <br /> For July 1., ------June 30, 119--­— <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Sttoted - <br /> 3. ❑ PERCOLATION TEST t _( <br /> R.S. or R,C.E. Name R.S. or R.C.E. No. <br /> Test Location Test Date/Time r ) <br /> 4. ❑ SANITATION PERMIT <br /> Job Address/Location 2035 E. Fremont St. Stockton `'Ca,., { f <br /> Owner 'Mr. Hathcoat I Address P•0. Box 1151, Lafayette, Ca. 94549 <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE P.1-T»----0-PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW '❑�REPAIR ® OTHER Septic Tank Removal <br /> 5. ❑ CHEMICAL TOILETS For July 1, -June 30, 191 <br /> :Type Construction Disposal Site l <br /> No. of Units Equipment.Stoi'age/Cleaning Location(s) <br /> 6. 0:PACKAGE TREATMENT PLANT For July 1, -Jyne 30, 19 E <br /> OperatorName 1. - Where Certified <br /> Plant Location <br /> F' <br /> Plant Capacity = No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19— <br /> SIZE: <br /> 9 SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. i f <br /> t <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ortlinances, state laws, and_rsand regulations of the n Joaquin Local Heah District. <br /> APPLICANT'S SIGNATURE X <br /> a <br /> .. -. FOR DEPARTMENT USE ONLY i- <br /> Fee IS Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH, ❑ January 1 &Received By January 31 ❑ duty 1 S Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION PATE- DATE REMITTED AMOUNT DUE CHECKED <br /> - <br /> f (, AMOUNT <br /> ri % ✓ .[ �/ <br /> FEE <br /> LESS ! r," <br /> PRORATION <br /> PLUS <br /> PENALTY / <br /> OTHER * <br /> OTHER t <br /> Received by IDate lu Receipt No. Permit No. , Issuance Date Mailed Delivered <br /> -`APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERM ITISERVI CES' 1601 E.HAZELTON AVE.',P.O.Box 2009 STOCKTON,CA 95201 <br />