Laserfiche WebLink
Applications Will Be Pro,^ssed When Submitted Properly Completed. Be Surf To Sign The Application. <br /> _ APPLICATION <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> ENGINEER'S AND/OR IF VEHICLE INVOLVED,GIVE <br /> APPLICANT'S AND/OR FOOD ESTABLISHMENTS. HOUSING Make <br /> CONTRACTOR AND/OR PUBLIC POOLS.WATER SAMPLING <br /> BROKER AND/OR HEAL ESTATE INSPECTIONS LIc. No. <br /> .IrENSE AND/OR POULTRY RANCHES AND KENNELS <br /> 3TRATION MISCELLANEOUS SERVICES Re9ist. NO. <br /> i. <br /> SER Color <br /> Application Date Jan. 4, 1989 Business/Name To Appear On Permit STOCKTON CONTRACTING GROUP, INC. <br /> «Type Permit/service Requested: Underground Tank Closure <br /> Applicant Name Stockton Contracting Group Addr ss 1000 N. Union Street t n. a. <br /> (209 462-50 (209) 462-1481 <br /> Business Telephone No. Emergency Telephone No. <br /> i Property Location/Address 6800 Fairchild Road <br /> d Property Owner Down River Forest ProductsAddress 1221 N. Golden ateAve. Ca. <br /> Operator's Name Gary Weber Address 1221 N. Golden Gate Ave. n. La. <br /> 1. FOOD ESTABLISHMENTS Total Building Sq. Footage Restaurant,Maximum Seating Capacity <br /> ❑ RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY <br /> ❑ ROADSIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> ❑ CONFECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR <br /> ❑ VENDING MACHINES/No. of ❑ MOBILE FOOD PREP. UNIT ❑ VENDING VEHICLE <br /> 0-FOOD CROP HARVESTING/No.of Field Employees <br /> ALL APPLICANTS: Total Employees Including Operators <br /> 2. HOUSING �RTorj <br /> IF- <br /> 0 OT Vof Units ❑ CERTIFICATE OF O <br /> 0 <br /> M013 <br /> 1LE HOME PARK/No. t9E7 Y Y <br /> of Spaces <br /> 3. WATER QUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER JAN tj 1989 <br /> NO. OF PUBLIC SERVED (Connections) <br /> 4. RECREATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL �' If 'LHEALTH <br /> S. VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds r i RVICES <br /> r :ENNEL/Runways /Animal Population No. No.of Confining Cages <br /> Sewage Disposal Method -- <br /> Solid Waste Disposal Method <br /> Water Supply Source Animal Waste Disposal Method <br /> S. ❑ CONSULTATION FEE <br /> 7. FE PLAN CHECKING FFA <br /> 8. REAL ESTATE <br /> REQUEST: Water Well Inspection Sample❑ Title Company <br /> Sewage System Inspection ❑ Address Tele. No. <br /> Escrow No <br /> Seller Seller Address <br /> Telephone No. Seller Agent Name <br /> Service Request For Date <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 laws, and rules and regulet' Its of the San Joaquin Local Health District. <br /> APPLICANT'S SIGNAT X 1 11 Title — Date kLW <br /> F R DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER INIT ❑ PER SIT ❑ EACH ❑ January 1 8 Received By January 31 ❑ July 1 8 Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE S <br /> BASE EXPLANATION DAMOUNT DUE CHECKED <br /> ATE DATE REMITTED <br /> AMOUNT_ <br /> FEE S <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Re&46d by batet Receipt No. Permit No. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Boa 1003 STOCKTON,CA 9590 <br />