Laserfiche WebLink
rAI.ILIIY <br /> r <br /> MAILING ADDRESS <br /> c ADDRESS <br /> a <br /> If <br /> 1• Operatin --- - ,, ----- — -- - - _ _ <br /> g Peraft <br /> Appltcetion/Annual fns Boa mo 8� eco <br /> a•` 4frst':Tarik a pectfon Fee �� <br /> t Fac f l f tv P $150. <br /> - - <br /> b• Additional Tanks (/ <br /> State SurchAdditional Tanks x S50) <br /> arQe (per{ Pe tank) (Due with Penait Application <br /> on renewal or a"Kndinent, of Operation rAYMV_MT �— <br /> (SS6 x Total permit and te"ra ECEIVLD <br /> 3. 4 _� Tanks) ry closure <br /> Temporary Closu JUL 27 <br /> re (Per tank) Underground Storage Tank in which <br /> storage has ceased butrwhere the own <br /> re-use tank within 2 er/operator p►-oposes to WyjRONMENTAL HEALTH <br /> (� years, pERMITISERVICES <br /> 4. "Pe T"Porary closures x S80)_ <br /> ^t"anent Closu (See-above 13 to calculate surcharge) <br /> ` re (Per tank) Under <br /> storage has ground Storage Tank in which <br /> ceased and where the ownerloperator has no intent <br /> of 'rel_using tank <br /> Pe rmanen _ - <br /> t Closures x $90) <br /> S. Plan Check F «S - , d�<,w; 9 �tm. .� <br /> Fee 530. <br /> v <br /> Total Number of Tanks ( ' <br /> Total Fee Due <br />• Make all f <br /> ees payable to <br /> t San Joa uin Local Health District, Enclose~' h your check this worksheet <br /> ExnM� � <br /> 1 �inrtu•t 1 Fee ,(o V Fac i 1 t tv Mt t 4 <br /> ttr• 1, I upr-r•rrl• <br /> I w•t•,t • �i 1 ) <br /> tltlruT ( at 11t :Y l;t Tartj <br /> tr. 3 :.r�ct t t t c►na I T.tnr,.. x SS() <br /> S 1 SO <br /> Star• Sur'chargr•. 4 Tank,, xISO <br /> S56 224 <br /> Total Number of TankS 4 <br /> — Total FCe Due 5524 <br />'both closures will <br /> b� conditioned ::;Contact a Ne <br /> alth District R� <br /> 136 resentative. <br /> —1_- <br />