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Applications Will Be Prok When Submitted Properly Completed. Be Sur Sign The Application. tv <br /> N, APPLICATIQN <br /> ENVIRONMENTAL HEALTH IERMIT/SERVICES 3z ,y <br /> ENGINEER'S AND/OR IF VEHICLE INVOLVED, GIVE <br /> APPLICANT'S AND/OR FOOD ESTABLISHMENTS,HOUSING Make <br /> CONTRACTOR AND/OR PUBLIC POOLS.WATER SAMPLING <br /> BROKER AND/OR REAL ESTATE INSPECTIONS Lic. No. <br /> Ir'ENSE AND/OR POULTRY RANCHES AND KENNELS <br /> 3TRATION MISCELLANEOUS SERVICES RegiSt. No. <br /> I. AER Color <br /> rApplication Date AUGUST 23, 1988 Business/Name To Appear On Permit Guild Winexi-es_andT)isti1 1 Aries <br /> Io Type Permit/Service Requested: Report Review <br /> 'Applicant Name Guild Wineries and Distilleries Address One tPrcgay Lodi, CA 95240 <br /> Business Telephone No.(.2_09j- 368-5 15 1 Emergency Telephone No. <br /> -Property Location/Address 0 e Winemasters.'._Way L di, CA 952 0 I <br /> aProperty Owner 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%AHOLESALE ❑ MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY <br /> ❑ ROADSIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT I <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 ill <br /> ALL APPLICANTS: Total Employees Including Operators P�T!• ,0 <br /> 2. HOUSING <br /> ❑ HOTEL/MOTEL/No. of Units ❑ CERTIFICATE OF OCCUPANCY <br /> ❑ MOBILE HOME PARK/No. of SpacesJ 1�= <br /> 3. WATER QUALITY 11WATER SAMPLE (Bacterial) ❑ CHEMICAL WIN <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATE HAULER &0 \Ctc, <br /> NO. OF PUBLIC SERVED (Connections) <br /> ��� <br /> 4. RECREATIONAL HEALTH 11 SWIMMING POOL 11 SPA 13 WADINGPOOL 11 NATURAL BATHING PLA E <br /> 5. VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds <br /> :ENNEL/Runways /Animal Population No. No.of Confining Cages <br /> Sewage Disposal Method <br /> Solid Waste Disposal Method <br /> Water Supply Source Animal Waste Disposal Method <br /> 6. ® CONSULTATION FEE 35 1)er Report "Final Remediation Report" dated <br /> 7. ❑ PLAN CHECKING FEE <br /> 8. REAL ESTATE <br /> REQUEST: Water Well inspection❑ Sample[] Title Company <br /> Sewage System Inspection ❑ Address Tele. No. <br /> I <br /> Escrow No. <br /> Seller Seller Address <br /> Telephone No. Seller Agent Name <br /> a <br /> Service Request For Date <br /> I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, a uIessand44Tjtl4Wions OT Man Joaquin Local Health District. <br /> Kleinfelder �+-,043 i <br /> APPLICANT'S SIGNATURE X TitleProject Geologist Date 1S <br /> FOR DEPARTMENT USE ONLY <br /> Fee IS Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Received By July 31 41 <br /> REMIT <br /> BILLING REMIT ANCE $ <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE � � <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit No. Issuance Date Mailed Delivered , <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Boa 20109 STOCKTON,CA 9$201 <br />