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Appilcagorr WIG Be Processed lylren submitted Prop"Completed.Be Sure To SW The Application <br /> 5(ForAPPLICATION 0 !5— <br /> (Far <br /> Non-Tronsterob%.Revocable,and Saspendable) SCPTAG� Q <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE -� <br /> Appl is tton,s thereby maOe tO"try On brrSmeas in the junsdretion it area of the San Joaquin Local Health District <br /> Business Nanta IDBAI v q. AARL1t A' ' SOW S-__.___-__ Address PO B!X <br /> Owner Addreae <br /> F.,m Partners.AdCresses and Telephone Nun.bers <br /> Business Telepnone No �/4G-.9407_-_ - - _.._ __ _ .. Emergency Telephor No.-_ __ _ <br /> Contractor L.CenLe No. __?SJ0.3y3_._ __ <br /> a <br /> Applicants Name(Print) Title 65 ` __ .__— Dale L_L7-17p <br /> Please diet*AppMeable Calpory(1-7)and Fol N Me Required Inlonnatlen <br /> 1. 0 PUMPER VEHICLE PERMIT REGISTRATION(FOR EACH VEHICLE) <br /> For July 1, June JCI, 19 .. Disposed!Sdey <br /> Descr,pl,on(Makti t.Color)_- <br /> Serial No _ _ _ _ ___ ._ . CAL License No. _._ _.. ..___ CAL License Renewal No. <br /> Capacity .. __ _-.-_- Gel..Weghte A Measures No. . <br /> Eowpment Parking Addrlw <br /> 2. 0 PUMPER YARD - <br /> For Jufy 1.--_ June J0. 19 .__ .. <br /> No.OI Vehicles Stored <br /> No of Chemical Toilets Slo,ed <br /> J. 0 PERCOLATION TEST <br /> RS.or R C.E.Name _ . . .__—._ _ .- RS.or R.C.E.No. <br /> Test rm <br /> t Location ._____. __ ._..._.-__—__. _ _ _- Test Date <br /> e. W SANITATION PERMIT <br /> Job AddresuLorahon _�is90 S._/t+�y_99, Smc x ra_.1.. 9ss.f'. <br /> C«rwt-�ii22s_-S7DCK n.V_Na/�rr�f/e_,>3rd.Er�padresKse SA.M6 <br /> O SEPTIC TANK 17 CESSPOOL la LEACHING FIELD FySEEPAGE PIT O PACKAGE PLANT <br /> 1M PERMANENT 0 T=MPORARY 0 NLW 2t REPAIR 0 OTHEP <br /> S. 0 CHEMICAL TOILETS Fell July 1.-June 30. 19 1144 <br /> Type Construction Disposal Site <br /> Plo of Umts Eompnent Storage:Clearing LoGftioMSl <br /> e. 0 PACKAGE TREATMENT PLANT For July 1.-June 30. 19 <br /> Operator Naas Where Gahhed <br /> Plant L ocahon <br /> Plant Capacity No Uma Sened <br /> T. 0 LAUNDRY For July 1. -Jeha 30. 19 <br /> SIZE 0 Less Shan 1 000 SO Ft. 13 Mom Than I.JCJ Sq FI <br /> 17 DRY CLEANING.Crie.nruls Used/Amount,Mo -----— <br /> I here:)/ Cady that I Pare pepMep m.S Applrtat that the w0'n will de dOha 1p.1000rdin[¢WIm Sart J9¢QWn Courtly <br /> "J ICM.state It".wild MJand rlg/uJ"g ,O 1M Jo&Qu'n LOC It Health District <br /> APPLICANTS SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due:O wNwuwLL. OrtNLtwf T MQVIE O[A<.. ❑ _ •sn........a.I.. w.)r Ow.r+s A+.....a ar a+. <br /> Allay <br /> BAs( AN.Vy' A[Pruyc[ f <br /> Fafs wr.wfipa w¢OIX.r ollf CrrECwv.p <br /> // putt ^Ar[ A[•r.•:(D Auoyar <br /> FEE G <br /> LESS <br /> gLpAwlipM // <br /> PLUM <br />