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Applications Will BePWhen Submitted Properly Completed. Be ign The Application. <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH PER IT/SERVICES <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 /> IrENSE AND/OR POULTRY RANCHES AND KENNELS Regist.No. <br /> 3TRATION MISCELLANEOUS SERVICES`` g <br /> I _.aER Color <br /> (Application Date Business/Name To Appear On Permit Lovelace Transfer Station <br /> oType Permit/Service Requested: <br /> Applicant Name Lovelace Transfer Station / SJ CO rOT P. 0. Box 1810, Stkn 95201 <br /> a Business Telephony o. Emergency Telephone No.` <br /> a Property Location/Address Lovelace Rd. , Manteca <br /> 6 Property Owner SAN JOAQUIN COUNTY Address P• 0. BOX 1810 STOCKTON' CA 95201 <br /> [Operator's Name Address <br /> 1. FOOD'ESTABLISHMENTS _ Total Building Sq. Footage Restaurant, Maximum Seating Capacity <br /> RESTAURANT 0 FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT 0 BAKERY <br /> ❑ ROADSIDE FOOD STAND 11 LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> ❑ CONFECTIONARY STORE 0 FOOD SALVAGER ❑ FOOD DEMONSTRATION 13 FOOD VENDOR <br /> 11 VENDING MACHINES/No. of ❑ MOBILE FOODPREP. UNIT ❑ VENDING VEHICLE <br /> ❑ FOOD CROP HARVESTING/No. of Field Employees. <br /> ALL APPLICANTS: Total Employees Including Operators <br /> 2.. HOUSING <br /> ❑ HOTEL/MOTEL/No. of Units ❑ CERTIFICATE OF OCCUPANCY <br /> MOBILE HOME PARK/No. of Spaces <br /> 3. WATER QUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER <br /> NO. OF PUBLIC SERVED (Connections) <br /> 4. RECREATIONAL HEALTH 0 SWIMMING POOL 13 SPA ❑ WADING POOL ® NATURAL BATHING PLACE <br /> 5. VECTOR CONTROL 0 POULTRY FARM/Maximum No. of Birds <br /> r ,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. 93 CONSULTATION FEE Sol i d Waste - 5 Year Permi t Revi ew <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 /> Escrow No. <br /> Seiler Seller Address <br /> Telephone No.— Seller ,Agent Name <br /> Service Request For Date <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 re ulations of the San Joaquin Local Health District. <br /> SOLID WASTE <br /> APPLICANT'S SIGNATURE Title MANAGER Date <br /> NJ <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 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION AMOUNT.DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE 840.00 see attached 4/2/90 $840.00 <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 /> 1 APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE„P.O.Box 21109 STOCKTON,CA 95201 <br />