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--�,� ..a....,, .,.. ..� . .....� ��.. .. ..... .. APPLICATION~.... <br /> ( '4- -Transferable, Revocable,and Suspendable) <br /> I� <br /> ENVIRONMENTAL HEALTH PERMIT SEPTAGE <br /> LIQUID WASTE I3 <br /> • �i <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> McDonald Septic Tank Service 4645 Hi.ldre-th Ln <br /> Usiness Name (DBA) Address <br /> Owner T. R. McDonald Address Stockton, Ca 95212 <br /> I <br /> I ; <br /> m Partners,Addresses and Telephone Numbers <br /> siness Telephone No. 931-0497 Emergency Telephone No. 957 <br /> L-i -4E327 <br /> II <br /> Contractor Licence No. 308171 � <br /> Anplicants Name (Print) H• McDonald Title Owner Date <br /> #ease check:Applicable Category (1-7)and Fill in the Required Information <br /> '1 r ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, June 30, 19 Disposal Sites <br /> scription(Make/Yr., Color) <br /> ,rial No. CAL. License No. CAL. Liccase RenewaE No. <br /> Capacity Gal.,Weights & Measures No. <br /> Iuipment Parkin&'Address <br /> ❑ <br /> PUMPER YARD <br /> or July 1, June 30,19 I' <br /> i <br /> No. of Vehicles Stored � <br /> fo. of Chemical Toilets Stored <br /> i, <br /> i -' ❑ PERCOLATION TEST r 1, f <br /> R.S. or R.C.E. Nance R.S. or R.C.E. No. - <br /> 13 <br /> est Location Test Date/Time <br /> ❑ SANITATION PERMIT f <br /> Job Address/Location <br /> owner�.._ Address I� <br /> iW <br /> VSEPTIC TANK 11 CESSPOO LEACHING FIELD CI SEEPAGE PIT ❑ PACKAGE PLANT,. I; <br /> PERMANENT ❑ TEMPORARY NEW ❑ REPAIR ❑ OTHER <br /> 5_ ❑ CHEMICAL TOILETS For July 1,-June 30, 19 I� <br /> hype Construction Disposal Site <br /> Lo.of Units Equipment Storage/Cleaning Location(s) <br /> I� <br /> 6. 11PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> M1 <br /> perator Name Where Certified <br /> r <br /> dant Location <br /> Plant Ca acit No. Units Served 1 <br /> p y .. <br /> 7. ❑ LAUNDRY For July 1,-June 30, 19 t� <br /> LZE: ElLess Than 1,000 Sq. Ft., 11More Than 1,000 Sq. Ft. <br /> DRY CLEANING, Chemicals Used/Amount/Mo. A <br /> ` F , <br /> '71 i� \,''yyr�s �� ^�- J ' �..�e [ - <br /> I hereby certify that I have prepared this applicati6 VV tFtat�the work will be done in accordance with Sauin`CountT' . <br /> ordinances, state laws,and ru es and regul ns of the San Jo uin Local Health Di51 '� z` n` <br /> APPLICANT'S SIGNATURE X- <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due_ ❑'ANNUALLY ❑ PER UNIT" ❑ PER SITE ❑ EACH _ ❑ January 1 &Received 8y-, nuary 31 ku-my Reteive y Suly 31 h <br /> REM{T <br /> BASE EXPLANATION BILLING REMITTANCE $! A T DUE ECKED <br /> DATE DATE REMIT AMOUNT <br /> FEE <br /> Ll LESSPRORATION PLUS ` <br /> II PENALTY " <br /> U <br /> OTHER <br /> O-HER <br /> LIPermit N _ I u n e a Mailed DeliveredU: '' APPeceivedCANT—RETURNALLDate COPIES TO: ENYIRONM@NReceiptNo_TAL HEALTH PERMIT/SERVICES 1607 E..HAZEL E,P.O.Box 2009 STOCKTON,CA 95201 <br /> L <br /> . H, <br />