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licaCo s Will Be Processe n Submitted Properly Complete . e Sur h 'cat <br /> :r <br /> AU G 2 8 1979 APPLICATION � �I � <br /> (For Non-Transferable, Revocable, and Suspe ) JOAQUIN LOCAL SEPTAGE <br /> SAN JOAQUIN LOtVIRONMENTAL HEALTH PERT <br /> HEALTH DISTRICT . LIQUID WASTE EALTH DISTRICT <br /> i Application is hereby made to carryon business in the jurisdictional area of the San Joaquin Local Health District <br /> y Business Name (DBA) Comi no Real-Nobile Home Park Address 1582'0 S. Harlan Rd., T ATHR.OP <br /> WOwnerComino Real Mobile Nome Park Address <br /> u.Firm Partners, Addresses and Telephone Numbers LATHROP INVESTORS , 445 W. Bullard, 1p5 r Fresno, CA _ <br /> CL <br /> Business Telephone No. (2 O 9 ) 4 3 5—4 4 O O Emergency Telephone No. 93704 <br /> Contractor Licence No. <br /> LApplicants Name (Print) Nelson Weersing Title Agent for Owner Date 8/27/79 <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. CAL. License Renewal No. <br /> Capacity Gal., Weights & Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> r <br /> For July 1, June 30, 19 LA <br /> f No. of Vehicles Stored ptl <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. <br /> Test Location Test Date/Time <br /> 4. ❑ SANITATION PERMIT <br /> Job Address/Location 1 <br /> Owner Address <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑"LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT _11. TEMPORARY., U..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.M1PACKAGE TREATMENT PLANT, For July 1, -June 30, 191980 <br /> Operator Name George Osborne Where Certified <br /> Plant Location N.E. corner Thomsen & Harlan Rds, San Joaquin County <br /> Plant Capacity 30, 000 gal No. Units Served 167 <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 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state s, a es nd regu 'on*of San Joaquin Local Health District. <br /> oil <br /> APPLICANT'S SIGNATUR a <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due. ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July t &Received By July 31 <br /> REMIT !I <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT I <br /> d <br /> FEE 1120.00 1 year 8 �� <br /> LESS l <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> i <br /> I <br /> OTHER <br /> OTHER <br /> y - IRec ved Date Receipt No. Permit No. .,., Issuance Date Mailed Delivered i <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON.AYE„P.D.Box 2009 STOCKTON,CA 95201 1 <br /> I <br />