Laserfiche WebLink
Eck) iti•,':L, H I �Ci jT a I''..TIDH C.l 4-1'+-9�7 4�7F'I°I \ ._� ITT G3� 2094655' 3?J 14 2 <br /> STVN . SER . STRT . EQUIP .CO Tf�hdo � �`�j Rf�19 , 90 14 : 32 IJo , 0U3 P .U2 rU. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE NORKSHEET <br /> Zff NAME FACILITY CONTACT NAME <br /> L STREET ADDRESS =^ <br /> SITE PHONE 1 wr•M A111A case <br /> 1p- rte , _ BSSHIti lfE . .;2t�t{4��. � -1 <br /> Y CITY / SrATE TIP CODE 1 0l Tanks <br /> _ STY IC;TO - <br /> at Site <br /> APPIICANI/81LUNG NAME <br /> P APPLICANT CONTACT NAME^� <br /> YCY.k"Cr?JZ Cs� `- LT3�LS QS_ <br /> fAPPLICANT PHONE 1 n=n As[A eoeR <br /> N CIT� �� ::NK <br /> ._ _ —_ <br /> 1 c TCk SST�I LIP CODE TYPE of IP <br /> PLICATIpN — <br /> lY?11__._� `" " C�S`�C� cwsus[. rnsrA«Ar1on, eye. <br /> .__._.1_.__ _—_...— <br /> FACILITY FEE _ 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> . .._. _ u �jam•).___ <br /> C 1986 1981 1988 1989 <br /> E TANK FEE a 150.00 each TANK <br /> F 1 Tanks 1150.00 1986 DO?. 1988_ ►989 <br /> A lmultipf I'by lee for - <br /> C each year appli(pble) �� — __E,— — <br /> STATE SURCHARGE •^{5�M0 each TANK, (see CA HEALTH 1 SAFETY CODE Sec T528T for applicability) <br /> T 1 Tanks [ 156.00 198b 198? E <br /> 988 19117 - <br /> Y (enter HOW and year) _ T <br /> C PERMANENT tIOSURE (Removal or Closure-in-place) <br /> 5 CLOSURE FEE [ 190.00 each TANK-__-�--- t Tanks I'D.LO <br /> E TEMPORARY CLOSURE Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE • $00.00 each TANK I Tanks 1190.00 f �_ <br /> _ .__ __ . -.w ---- __. <br /> P PLAN CHECK (Tnstaiiation or Repair) <br /> L .._. <br /> A _ -pp pp <br /> N PLAN CHECK FEE ■ 100.00 Rich SUBMISUON/k 111,S51 )I"go Amount <br /> REPAIR <br /> R TANK REPAIR FEE R 1110.00 each TANK1110. <br /> 00 <br /> +n s x <br /> 1 A PIP186 (Fees our, minimum one hour to be paid on plan submi_.._. ...,.•.. <br /> PIPING REPAIR/CLOSURE/REMOVAL IFees are per h , - submittal) <br /> R UNAUTHRlt cale ASE EVALUATION CONSTRUCTION INSPECTION _S_A,M_L_I_NG.._..I_lI_SP.-E_C..,T._I._ON+DDb <br /> _ <br /> when <br /> (whip,appll{able)FEE • 135.00/hr (When applicable) <br /> TEE • 130.00/hr ,_...... __..___. _----... .�__.. _..,_._.............._..... <br /> FEE = 175.00/hr <br /> TOTAL DUE - 1� <br /> i OFFICE ISE ONLY <br /> WWII <br /> SVEEPS 1 CON !C LOC fOOE DISE CODE An0UH1 DUE AMOUNT ROD 1L�ICC-C'YI(ASM �DY DATE PfCCIV D PERMit 1 <br /> _ <br /> - .L� �C <br />