Laserfiche WebLink
APPL4_ATION <br /> (For Non-Transferable, Revocable, and Suspendable) SEPTACE <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 /> w <br /> Business Name (DBA) WONG ENGINEERS . INC e ___-._ Address • 578 FEATHER RIVER DR.SUITE A <br /> i Owner ------- 5G.,_—CHANCE GONG Address STOCKTON.CA 95219- ---- <br /> Y Firm Partners. Addresses and Telephone Numbers _ <br /> aBusiness Telephone No. ___ _ 476-0011 _ Emergency Telephone No. <br /> Contractor Licence No. -- <br /> a Applicants Name (Print) C . CHANCE WONG _ Title FRES. Date T-13-92 _ <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(MakeNr., Color) <br /> Serial No _ CAL License No. CAL. License 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. IN PERCOLATION TEST <br /> R S. or R.C.E. Name C. CHANCE WONG _ R.S. or R.C.E. No. K.C.E e 14269 <br /> Test Location X995 S._ NOBLE Y ROAD Test Date/Time -- <br /> 4. <br /> 4. ❑ SANITATION PERMIT MS-92-105 <br /> Job Address/Location <br /> Owner _ _. --- Address <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR ❑ OTHER <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 /> "Sao KlNv11M =ta MN�M+MtivMllhMwllw� tf �nttNperwilit lk+OtMeworkfaWhic MIS NoolsesfwdIShall soemplevalype" <br /> r <br /> in Six rn&MI,IK 1s�im MSN W�MMi �t flf�l <br /> asomogw,s r I"1 11 he <br /> } 1 as1l�t►�t in tM pM*�rl0ance sit t11s wart for sl�idl t�i�OP'�N iKYtA,1 sh72 <br /> woweK..l�''' tlIs1".d"i=4101 .+'dt.a»�'��"• / <br /> I hereby certify that I have prepared this application n t the work will be done in accordance with S Joa n Go my <br /> ordinances, state laws, and ru n ions of t a J quin Local Health District ;' r �l <br /> APPLICANT'S SIGNATURE X — — -- <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Receiv REMITBy uly 31 <br /> BASE EXPLANATHON BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> PATE DATE REMITTED AMOUNT <br /> sw <br /> FEE <br /> LESSvn`[ <br /> PRORATION - <br /> PLUS <br /> PENALTY <br /> OTHER — <br /> OTHER _ <br /> R ,i y�,--- r dal ReceYo' ` SrNc� issuance Dale Mailed Delivered <br /> FIAVIAnNMENTAL HEALTH PERMIT/SERVICES 1601 E.HA2ELTON AVE.,P.O.90■2009 STOCKTON.CA 95201 <br />