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0616S 13' 'n <br />Received by Date Receipt No. Permit No lssu nce Date Mailed <br /> All'PLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1901 E. HAZELTON AVE., P.O. Boa 2009 ST N, CA .9 <br />Equipment Parking Address <br />2. 0 PUMPER YARD <br />For July 1, June 30, 19 <br />No. of Vehicles Stored <br />No. of Chemical Toilets Stored <br />Test Location <br />1g 'SANITATION PERMIT <br />Jots Addr Location <br />Owner <br />0 SEPTIC TANK 0 CESSPOOL <br />twAr PERMANENT 0 TEMPORARY <br />0 CHEMICAL TOILETS For July 1 <br />Type Construction <br />No. of Units Equipment Storage/Cleaning Location(s) <br />0 OTHER <br />Address <br />0 LEACHING FIELD %SEEPAGE PIT 0 PACKAGE PLANT <br />0 NEW %REPAIR <br />June 30, 19 <br />Disposal Site <br />3. 0 PERCOLATION TEST <br />R.S. or R.C.E. Name R.S. or R.C.E. No. <br />Test Date/Time <br />0 PACKAGE TREATMENT PLANT For July 1,- June 30, 19 <br />Operator Name <br />Plant Location <br />Where Certified <br /> No. Units Served 3 Plant Capacity <br />0 LAUNDRY For July 1, - June 30, 19 <br />SIZE. 0 Less Than 1,000 Sq. Ft., 0 More Than 1,000 Sq. Ft. <br />0 DRY CLEANING, Chemicals Used/Amount/Mo. <br />1 hereby certify at 1 h <br />ordinances, state.laws. an <br />this application and tha <br />regulation the Spr <br />he work will be done In accordance with San Joaquin County <br />Locatlealth District <br />APPLICANT'S SIGNATURE X <br />FOR DEPARTMENT USE ONLY <br />January 1 Reeeivad By Jaquary 31 0 July 1 & Receivcci By July 31 <br />ree I* LUC I-..., 55,51155,1,1-.15. <br />1. <br />I 55.5a 5 1.4 <br />BASE <br />5 5-5^.155 • 5.. -.- <br />EXPLANATION <br />... - — — <br />BI LLING <br />GATE <br />i REMITTANCE <br />DATE <br />$ <br />REMITTED <br />AMOUNT DUE <br />REMIT <br />CHECKED <br />AMOUNT <br />FEE . <br />LESS <br />PRORATION <br />t-- e <br />PLUS <br />PENALTY t-v <br />OTHER <br />/ -7/ OTHER _L _i__ , . <br />;Business Name <br />4 <br />Firm Partners, Addresses and Te <br />t. Business Telephone No <br />Contractor Licence No. <br />Applicants Name (Print) <br />Owner. ilik4rcht Address __IgOwS. <br />hone Numbers <br />4/Z, <br />Please check Applicable Category (1-7) and Fill in the Required Information <br />1. 0 PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br />For July 1,. __June 30, 19 Disposal Sites <br />Description (Make/Yr., Color) <br />Serial No. CAL. License No. <br />Capacity Gal., Weights & Measures No. <br />Applications Will Be Processed When Submitted Properly Complete0. tie 1.1/c u <br />APPLICATION <br />(For Non-Transferable, Revocable, and Suspendable) <br />ENVIRONMENTAL HEALTH PERMIT <br />LIQUID WASTE <br />/3/41 IZZ <br />AtiplicWrettypte to carry on business..4,14V1sdictional area of the San Joaquin Local Heal Dis ict r. <br />,s* gre Address __Z-7 <br />Emergency Telephone No <br />Title <br />CAL. License Renewal No. <br />SEPTAGE