Laserfiche WebLink
^yWR.�Uwu wm u.rqw.AA.M wuur rr a •,. ry J ..uu,yr - <br /> • yu r r.yyauy <br /> NVIRONMENTAC'H PERMIT/ !8 t` <br /> •ENGINEER SANG/ONAPPLIC <br /> CONTRACTOR <br /> OR r{{{E8TA{LISNMINn,NoesUN IF VEHICLEI r OLYED,oryE / <br /> CONTRACTOR ANOIOa PUBLICPOOL{,MATIN{AMPUIN Mak <br /> a <br /> BROKER AND/OR NUL ESTATE IUPECTMNS ',::•• <br /> 1rc 3TANSE ANON POULTRY RANCNIA AND KENNELS LiC. NO. - - -- <br /> �. aERAnO - MISCELLANEOUS{EAYtCES C� �) Regist. No. <br /> Color <br /> �Application Dale ..-1.-1.4-88 Business/Name To Appear On Permit t <br /> w Type Permit/Service Requested'.. PHOTOCOPY OF RECORDS - BEECHNUT AND 11TH ST. <br /> Applicant Name TRACY _ <br /> 3z5 E. 3b�Fi TRAY F <br /> TKA6� BLVD. & BEECHNUT RD. TRACY. <br /> ._____ ! <br /> RADIAN CURPURATIUN ., Business Telephone No. Emergency Telephone No. <br /> Property Location/Address ATTEN_ .SUSAN SCHF.TREIL 10395 OLD DT A(` R TTT T F RD SACRAIEFh T(1 <br /> Propeny"ner —-------. ._ ----- - r <br /> Address <br /> [Operator's Name Address <br /> 1. FOOD ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity <br /> ❑ RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY <br /> ❑ ROADSIDE FOOD STAND ❑ LIOUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> ❑ CONFECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR <br /> ❑ VENDING MACHINES/No. of ❑ MOBILE FOOD PREP. UNIT ❑ VENDING VEHICLE <br /> ❑ FOOD CROP HARVESTING/No. of Field Employees <br /> ALL APPLICANTS: Total Employees Including Operators - <br /> 2. HOUSING <br /> ❑ HOTELJMOTEL/No, of Units ❑ CERTIFICATE OF OCCUPANCY <br /> ❑ MOBILE HOME PARK/No,of Spaces __- <br /> J. WATER DUALITY ❑ WATER SAMPLE(Bacterial) ❑ CHEMICAL <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER <br /> NO. OF PUBLIC SERVED (Connections) <br /> a. RECREATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE <br /> 5. VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds _ <br /> r :ENNEVRunways ____-_ .._.- /Animal Population No. —-_ No. of Conflning Cages <br /> Sewage Disposal Method <br /> Solid Waste Disposal Method - _- -- <br /> Wale, Supply Source Animal Waste Disposal Method <br /> 6. 0 CONSULTATION FEE <br /> 7. ❑ PLAN CHECKING FEE <br /> 8. REAL ESTATE -- <br /> REOUEST: Water Well Inspection❑ Sample❑ Title Company <br /> Sewage System Inspection 11 Address Tele. No. <br /> Escrow No. -- -- <br /> Seller . . Seller Address _ <br /> Telephone No Seller Agent Name <br /> Service Request For Dale - - -- <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 laws. and rules and regulations of the San Joaquin Local Health District. <br /> APPLICANTS SIGNATURE X Title _- Date.___ __._ <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUM I y O PtR UNI I ❑ PI n ,Ot ❑ tACH ❑ January I fly January 31 ❑ July I a aeCe•retl ay Jul, JI <br /> REMIT <br /> IOWNG 1 REMITTANCE <br /> BASE 1 RI'IANA lI11N L AMOUNT DUE CHECKED <br /> DATE DATE ' REMITTED AMOUNT <br /> I <br /> FEE $30 . U0 01U. REVIEW ANDUIt <br /> NU Py REG�U STEll—INFU <br /> - _.- .. - - — --- <br /> PRONATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> 9.60 96_ CUP LIES 0.10 <br /> OTHER 2 . 40 1 _POSTAGE $42 . 00 - -_ --- - <br /> RacenMW OAIe_ -. - -Nwr:eW All, - __PnmR No ..- ..-- Nuuaa nwr MUNa <br />