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80-345
EnvironmentalHealth
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SONORA
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1565
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4200/4300 - Liquid Waste/Water Well Permits
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80-345
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Last modified
7/3/2019 10:44:33 PM
Creation date
12/1/2017 10:00:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
80-345
STREET_NUMBER
1565
Direction
W
STREET_NAME
SONORA
STREET_TYPE
ST
City
STOCKTON
SITE_LOCATION
1565 W SONORA ST
RECEIVED_DATE
5/28/1980
P_LOCATION
CALIFORNIA CEDAR PRODUCTS
Supplemental fields
FilePath
\MIGRATIONS\S\SONORA\1565\80-345.PDF
QuestysFileName
80-345
QuestysRecordID
1929974
QuestysRecordType
12
Tags
EHD - Public
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Applications Will Be Processed When Submitted Properlycompletes. tlsesure Ivalv- 1•�nrr••�a• <br /> APPLICATION <br /> (For Non-Transterable, Revocable, and Suspendable) SEPTAGE <br /> —� ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin local Health District <br /> Business Name (DBA) World Enterprises, Ina. Address P •-0 - Box 8598* Stook O 95208 <br /> z Owner Address <br /> a <br /> J Firm Partners, Addresses and Telephone Numbers X66--071' <br /> CL Business Telephone No. — - 1-2 4 Emergency Telephone No. � <br /> Contractor Licence No. 26 6ZF <br /> Applicants Name (Print) Donald Z Wle Title Applicants <br /> Dated 8 $0 <br /> Please check Applicable Category (1-7) and Fill in the Required Information <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, June 30, 19 Disposal Sites <br /> Description(Make/Yr.,Color) <br /> Serial No. CAL. License No. GAL. L'sccnse Renewal No. <br /> Capacity Gal., Weights & Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. No. <br /> R.S. or R.C.E. Name <br /> Test Location Test Date/Time _ <br /> 4. ❑ SANITATION PERMIT <br /> Job Address/Location 1 6 W. Sonor Sto ktan C +6` <br /> Owner ria]i Ornia Cedar <br /> s Address--! 40 W W hin ton o k on C <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑rr, PACKAGE PLANT <br /> 13 PERMANENT ❑ TEMPORARY ❑ NEW 11 REPAIR MOTHER Septic Tank Removal <br /> 5. ❑ CHEMICAL TOILETS For July 1,-June 30, 19 {� <br /> Type Construction Disposal Site <br /> No. of Units Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, - June 30, 19 <br /> Where Certified <br /> Operator Name <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 <br /> SIZE. ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> I hereby certify that I have prepay this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules regulations th S Joaquin cal Health District. <br /> APPLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> Fee IS Due: © ANNUALLY ❑ PER UNIT 1)5 PER SITE ❑ EACH ❑ .January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> RASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE <br /> LESS ' <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> �p <br /> OTHER <br /> OTHER �`n} <br /> Permit NO issuance O to Mailed tDeliyer /Ill <br /> 7 <br /> Received by Date Receipt No.APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES16D1 E.HAZELTON AYE.,P.D.Box 201)9 STOC, ON,CA <br />
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