Laserfiche WebLink
Applications WIII Be Procet� When Submitted Properly Completed. Be Sure ti S&An The Application. <br /> APPLICATION <br /> racn,rensAND tm ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> ADPL ICANT'5 AND Un <br /> CONTRACTOR AND OR FOOD ESTABLISHMENTS.HOUSING IF VEHICLE INVOLVED. GIVE <br /> BROKER AND On PUBLIC POOLS.WATER SAMPLING Make <br /> I-FNSE AND OR REAL ESTATE INSPECTIONS <br /> :T nq nON POULTRY RANCHES AND KENNELS LiC. NO. <br /> I aEA MISCELLANEOUS SERVICES Regist. No. <br /> Color <br /> Application Date 12-6-90 Business/Name To A <br /> Type Permit:Service Requested $ Q Appear On Permit Former Ki I Patrick Bakery <br /> Applicant Name Herbst Engineering Inc, - After hours o <br /> Admeas 5 80-2n n <br /> Sacramento, Ca,� 95822 Business Telephone No th st. P.O. box 22504_ _ - <br /> PropertyLocatlon/Address 1717 S. center. St.--- Stockton, Ca.. Emergency Telephone No. <br /> Property Owner Frank Woodward _ -- -- -- ---- -- -- <br /> - -- -- Address _ <br /> Operator's Name Same a5 owner_. _ __ _ -- ------ --- - <br /> _ Address <br /> 1. FOOD ESTABLISHMENTSTotal Buil <br /> ding Sq. Footage Restaurant, Maximum Seating Capacity <br />:1RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br />:1 FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT <br />:3ROADSIDE FOOD STAND ❑ LIOUOR STORE El BAR ❑ BAKERY <br /> 0 ITINERANT RES <br /> I CONFECTIONARY STORE ClFOOD SALVAGER ❑ FOOD DEMONSTRATION TAURANT <br /> 7 VENDING MACHINESof 11 FOOD VENDOR <br /> I FOOD CROP HARVESTING/No. of Field Employees _ ____ 11_ ❑ MOBILE FOOD PREP. UNIT VENDING VEHICLE <br />.LL APPLICANTS: Total Employees Including Operators—_- <br /> HOUSING - - - <br /> HOTEL/MOTEL/No. of Units <br /> I MOBILE HOME PARK/No. of Spaces ❑ CERTIFICATE OF OCCUPANCY <br /> WATER QUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL <br /> PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER <br /> 0. OF PUBLIC SERVED (Connections) <br /> RECREATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE <br /> VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds <br /> :ENNEL/Runways /Animal Population No. <br /> wage Disposal Method - --- --- -- - No. of Confining Cages <br />,lid Waste Disposal Method - - -- - - - -- <br /> - — <br /> Iter Supply Source - <br /> ❑ CONSULTATION FEE — --- Animal Waste Disposal Method <br /> ❑ PLAN CHECKING FEE <br /> REAL ESTATE - - <br /> QUEST: Water Well Inspection❑ Sample❑ Title Company _. <br /> Sewage System Inspection ❑ Address _ <br /> Escrow No, _ _ --- - - Tele No <br /> Seller <br /> Telephone NoSeller Address <br /> . -- -- - - <br /> _ - ---- - <br /> Service Request For Dale Seller Agent Name - --- ------- - <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws. <br />'LICANT'S SIGNATURE X _ <br /> Title <br /> -. --_ Date_ <br /> FOR DEPARTMENT USE ONLY — <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT <br /> PER SITE ❑ EACH ❑ January 1 8 ReceivaC By Januar <br /> '— — - -- _ Y 31 ❑ July t A Received BTAMOUNT Jo,� n <br /> BASE F�tFl�lyq BILLING REMITTANCE 1 <br /> _ri DATE DATE REMITTED D <br /> $52.5b 1 Hr. Over ime <br /> FEE --- _..__. - --_- -.._._.-- — __ ---_ <br /> LE55 _. - - ._ _ —_.— <br /> PRORATION --__ —PLUSPENALrr --5.25 Penalty 1-25-91 <br /> IEn - -- -. - $hY Dal, _ — <br /> neceil+t No- -- Pelma Nn — _ -- - '---- <br /> APPLICANT—pETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMITISERVICES IHAZELT Dale MaileG DBBVBIM - <br /> tAar E HA2ELTON AVE..P.O.60, <br />