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Applicationshen Will Be Processed WSubmitted Property Completed, Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Non-Transferable.Revocable,And Suspendable) " <br /> T <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby maJeto carry on business In the jurisdictional aiLaDt the San JOa(jUm Local Health District <br /> wBumness.v,.me IDBAI McDonald Septic •< 3aakhoa Address 111>!1> iiildreth Lane- --- -- <br /> zOwnar_ T. RE McDonald Address . ;a;nu - - ---- - --- <br /> 0z Firm Partners,Addresses and Telephone Numbers --- -- - -- <br /> iBusiness Telephone No. ! 31-0497-- - - - "«•rprgancy Telephone No. _957-402_7 -- — <br /> .Contractor Licence No. j.g6_ _9 <br /> Applicants Name('rml) T- 1 d _- _ Vile 04:ner _.. Date__--_-- —I y <br /> Please check Applicable Category i/-7)and Fill In the Required Information <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION(FOR EACH VEHICLE) <br /> For July t, ___June 30. 19 __._ .. Disposal Sites ----- - ------� <br /> Description(Makeyyc,Color) - -- --'— <br /> Serial No. _—__ _ - _... .. -. ._CAL.License No. - T CAL.License Renewal No. <br /> Capacity _. — ___. Gal.,WJghts&Measures No. <br /> Equipment Perking Address <br /> 2. O PUMPER YARD <br /> For July L June 30, 19 - <br /> No.of Vehicles StoredNo.of Chemical Td•Ilets Stored _ _.-. _ --- __._. -. . -- — <br /> 3. ❑ PERCOLATION TEST <br /> P.S.or R.C.E.Name —___.- __._ R.S.or A E. Na <br /> Test Locationf <br /> �_] est Date/1 ime - - ---- <br /> a. ❑ SANITATION PERMIT 7 <br /> Job Address/Localwn }Ia_�L���C,,`.T/n�� T/'�{j� C I/ , . -- <br /> Owner—v-v�'v-a'Ef�-r"�k.-F-- -� / �Atl <br /> 17 SEPTIC TANK � CESSPOOL LJ LEACHING WLD SE6IjAGE'Pt r OL.WCKIAGE PC ANT r <br /> 13 PERMANENT ❑ TEMPORARY ❑ NEW REPAIR 17 OTHFR T <br /> 5. 17 CHEMICAL TOILETS For July 1. -June 30. 19 <br /> Type Construction _- Disposal Site <br /> No.of Units Equipment Storage/Cleaning LOCWRh,;5) --- --------- ---- -- <br /> 6. ❑ PACKAGE TREATMENT PLANT Fn:July 1,-June 30. 19 j <br /> Operator Name - where Certified IN <br /> Plant LocationPlant Capacity -_ - No Units <br /> 7. 13 LAUNDRY For July 1.-June 30, 19 - <br /> SIZE: Cl Less Than 1,(100 Sq. Ft ❑ More Than 1,000 Sq,FI. <br /> DRY CLEANING.Chemicals Used.'Amount/Mo. . <br /> I hereby certify that I hace prepared this application a. , ^IaI u.- -I i.l :fano In accordlnce with San Joaquin County <br /> ordinances.state laws.and fides an re ns of the <br /> -San <br /> `Jo.i•: .. Dnlllct <br /> APPLICANT'S SIGNATURE X. �/-r-4�%�/s-`YL-y'-c� <br /> FOR DEPARTME t, <br /> Fee Is Due: ❑ 6NNUP1 Lv ❑PER UNIT ❑ pfu•:ITL 0 "''. <br /> - "!I ❑ JVIY 1 b II.nrv.q UY tidy T <br /> NEMIf <br /> tEA'A LYPLANAtION TILT INIi AMOUNT OUE GNEMIt <br /> �Y{�(f,U DATE ••I•.•. AMOUNT <br /> LEE �% ",\ <br /> LESS <br /> PRORATION <br /> PLUS A <br /> OTNEil Y" <br /> w ii'.'rn :I <br /> �- IPPIiGANT-afiURN ALL COPI[S TO fNYINONNLNTAL NI Man I•tn!n„� uuz;11,2N AVE.. Po am 200% STOCKTON.CA TROT <br /> r S� <br /> i <br /> i <br />