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80-462
EnvironmentalHealth
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JOSEPH LEON
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4200/4300 - Liquid Waste/Water Well Permits
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80-462
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Last modified
7/6/2019 10:51:40 PM
Creation date
12/2/2017 6:40:23 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
80-462
STREET_NUMBER
4909
STREET_NAME
JOSEPH LEON
SITE_LOCATION
4909 JOSEPH LEON
RECEIVED_DATE
07/09/1980
P_LOCATION
BOB MATHEWS
Supplemental fields
FilePath
\MIGRATIONS\J\JOSEPH LEON\4909\80-462.PDF
QuestysFileName
80-462
QuestysRecordID
1801561
QuestysRecordType
12
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EHD - Public
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nPPnvalluns .rm oerrocessea wnen suomltea Properly Completed Be SureToSign The Application. <br /> APPLIISATI ON <br /> (For Non-Translerable, Revocable,and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT SEPI ,G "" <br /> LIQUID WASTE <br /> Appliction is hereb ade C rry on b iness' a jurisdictional area of t Sa Joaq�I cat! Ith Distric <br />{" y Business Name (DBA) ff Aydd'ress 1 <br /> a Owner 14 E' __��,_ _L`t` �L _ Address �J C <br /> J Firm Partners, Addresses an Tele hone Numbe s <br /> aBusiness Telephone No, Emergency Telephone No. <br /> Contractor Licence No. <br /> Applicants Name (Print) —_ <br /> L_ Title Date <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) f <br /> Serial No, CAL. License No. CAk. Liccnse Rencwal No. <br /> Capacity Gal., Weights & Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored +` <br /> 3. ❑ PERCOLATION TEST J <br /> R.S.'or R.C.E. Name R.S. or R.C.E. No. <br /> Test Location Test Date/Time <br /> 4. ❑ SANITATION PER�IfT �f <br /> Joh Addr s/Location S I; (r� LEC) <br /> Ow er Address:e L. e0 <br /> EPTIC TANK 11CESSPOOL EACHING FIELD 0 SEEPAGE PIT ❑ PACKAGE PLANT <br /> PERMANENT 13 TEMPORARY NEW ❑ REPAIR ❑ OTHER <br /> 5. 11 CHEMICAL TOILETS For July 1, -June 30, 19 <br /> Type Construction Disposal,rgite <br /> No. of Units Equipment Storage/,16leaning Location(s) <br /> 6. E] PACKAGE TREATMENT PLANT For July 1, -Ju ,30, 19 <br /> Operator Name r Where Certified <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ Mor Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/ o. <br /> I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws rules and r ulations of t e San Joa uin Local Health District. <br /> APPLICANT'S SIGNATURE <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNU LY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE <br /> LESS <br /> i <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> i <br /> OTHER <br /> i <br /> OTEIER <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.D.Box 2009 STOCKTON,CA 95201 <br />
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