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11 <br />SAN JOAQUN COUNTY <br />304 East Weber Avenue, Tkird Floor, Stockton, California 95202 <br />TeleFhone: (209) 469-3420 Fax: (209) 468-3433 <br />APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING REPAIR PERMIT <br />7M Pawff onims 90 DAYS MM THE AMMAL DATE. DMICATE PERUrT <br />L-k=REPARmETRoRT <br />► " � . �a . • +ter <br />• - • . �. Ott <br />• -VAM <br />.«. '..,P1 <br />h <br />. , . . 04 <br />i <br />W-71 <br />)- tc <br />_-Til j7i 17;7-77 <br />r. . <br />P LIApproved Lkwoved IAiat conditions U13isapproved <br />L (See Aftdmnt With Co ) <br />A <br />N Plan Reviewers Namq Date <br />..,�-."•- •. ♦ ♦: f' •• ,.y it ...�` i t '�: "�� -' • {. •.. .. ..�. >,.f ( `� :♦ � :::' � •. �: ••. v '� • <br />'.'/ �. ��. �. . 7.{.: • '.�. -�.".♦ : � : • •-.: :` •� I -.moi.... •-. - <br />�m <br />Indicate the responsible party to be billed for additional EHD staff fim e);iended beyond pemid payment cDverage per taniL If <br />the partydesignated below i differentft .. f permit <br />e t •:•.Ia«: i ♦. property <br />responsibility for the billing by signatine and date below <br />NAME <br />TITLESertJ 7, v d , «. <br />EH23DM (revised 8MM <br />1 <br />