Laserfiche WebLink
4 I Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Non-Transferable,Revocable, and Suspendable) / <br /> ENVIRONMENTAL HEALTH PERMIT SEPTAG� _ <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joa uin Lo alth Distr ct <br /> r i . Valley Mechanical Inc. P <br /> .O <br /> . <br /> 3ox Stocton 9S2a5 <br /> I, Business Name (DBA) Address <br /> I, o+±I George J. Fleck Address 0 S. Reid, Linden, CA <br /> Firm Partners, Addresses and ele ane Nlbers <br /> aBusiness Telephone No. 20 931` 031 Emergency Telephone No. <br /> a 'I 333319 <br /> Contractor Licence No. <br /> c a i George J..Fleekag_.a -. w= Title President tate <br />[ L Applicants Name (Print) -c- - <br /> Please check Applicable Category (1-7) and Fill in the Required Information <br /> 1_1 ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, June 30, 19 Disposal Sites l <br /> Description(Make/Yr., Color) <br /> Serial No. CAL. License No. _ <br /> CAL. License Renewal No. <br /> Capacity Gal., Weights & Measures No. <br /> f <br /> Eqluipment Parking Address <br /> 2.l i 11 PUMPER YARD <br /> I <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> Noi <br /> . of Chemical Toilets Stored <br /> 11.❑ PERCOLATION TEST <br /> R.S. or R.G.E. Name R.S. or R.C.E. No. <br /> I Test Location Test Date/Time <br /> 4] 00 SANITATION PERMIT <br /> Job Address/Location <br /> 5353 Beecher Rd. (San Joaquin County <br /> Owner Ed Trott Address 150 Gateway Ct. Apt. 21, Stockton 95207 <br /> ® SEPTIC TANK ❑ CESSPOOL IN LEACHING FIELD ❑ SEEPAGE PIT 13 PACKAGE PLANT <br /> IN PERMANENT ❑ TEMPORARY IM NEW ❑ REPAIR �' OTHER 1 — 1,600 Gal. Tank <br /> 51 ❑ CHEMICAL TOILETS For July 1, -June 30; 19 - — with 170` leach line <br /> i Type Construction Disposal Site 2 " t8 <br /> No. of Units Equipment Storage/Cleaning Location(s) µ <br /> 61 ❑ PACKAGE TREATMENT PLANT For Julyri, -Ju a 30, 19 - <br /> Operator Name Where Certified <br /> Plant Location <br /> Plant Capacity No. Units Served - <br /> 71 ❑ LAUNDRY For July 1, -June 30, 19 <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> f ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> I hereby certify tat hve prepared t application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state I s, and rules and g tion e S �Jca in Local Health District. <br /> #, s, , 71 <br /> APPLICANT'S SIGNATURE X <br /> ti <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ANNUALLY ❑ PER UNIT ❑-PER SITE ❑ EACH ❑ January 1 &Received Ry January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> - BASE EXPLANATIOBILLING REMITTANCE $N � _ � AMOUNT DUE CHECKED <br /> ,.i DATE ` " DATE. .- , REMITTED AMOUNT - <br /> FEE yS. - - _ �4 1 ° <br /> LESS ] <br /> PRORATION <br /> PLUS <br /> ' PENALTY <br /> OTHER ( eyS <br /> F 1 - <br /> r <br /> l OTHER 1 - <br /> c 1�3 <br /> Received by r _ - Date Receipt No. Permit No. Assu0ce t Mailed Delivered <br /> �_ l +APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Box 2809 STOCKTON,CA.852p_ <br />