Laserfiche WebLink
ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR UNDE0OUND TANK RETROFIT, OR PIPING REPAIR PERMI0 <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS. INDICATE. PERMIT TYPE BELOW: <br />TANK RETROFIT PIPING REPAIR <br />BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond <br />permit payment coverage per tank. If the party designated below is different than the permit <br />applicant, e.g. property owner, the party must acknowledge this responsibility for the billing <br />by signature and date below. <br />Name �q i4 1 a e dressi <br />