Laserfiche WebLink
Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br />APPLICATION <br />(For Non -Transferable, Revocable, and Suspendable) SEPTAGE <br />ENVIRONMENTAL HEALTH PERMIT <br />LIQUID WASTE <br />Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br />H Business Name (DBA) WONG ENGINEERS$ INC. Address 4578 FEATHER RIVER, SUITE A <br />i Owner CHANCE WONG Address STOCKTONr CA 95207 <br />a <br />Firm Partners, Addresses and Telephone Numbers <br />a. Business Telephone No. 4760011 Emergency Telephone No. <br />a <br />Contractor Licence No. <br />Applicants Name (Print) C. CHANCE WONG Title PRES. Date 23 FEB 67 <br />Please check Applicable Category (1-7) and FIII 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) <br />Serial No. CAL. License No. CAL. License Renewal No. <br />Capacity <br />Equipment Parking Address <br />2. ❑ PUMPER YARD <br />Gal., Weights & Measures No. <br />For July 1, June 30, 19 <br />No. of Vehicles Stored <br />No. of Chemical Toilets Stored <br />3. ® PERCOLATION TEST <br />R.S. or R.C.E. Name C. CHANCE WONG R.S. or R.C.E. No. R.C.E. 14269 <br />Test Location 1480 N. WHITE LANE Test Date/Time <br />4. ❑ SANITATION PERMIT MS -86-+3 <br />Job Address/Location <br />Owner <br />❑ SEPTIC TANK <br />❑ PERMANENT <br />❑ CESSPOOL <br />❑ TEMPORARY <br />Address <br />❑ LEACHING FIELD ❑ SEEPAGE PIT <br />❑ NEW ❑ REPAIR <br />S. ❑ CHEMICAL TOILETS For July 1, - June 30, 19 <br />Type Construction <br />Disposal Site <br />No. of Units - Equipment Storage/Cleaning Location(s) <br />6. ❑ PACKAGE TREATMENT PLANT For July 1, - June 30, 19 <br />Operator Name _ <br />Plant Location — <br />Plant Capacity <br />No. Units Served <br />7. ❑ LAUNDRY For July 1, - June 30, 19 <br />SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br />❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br />I hereby certify that I have prepared <br />ordinances, state laws, and rules arA <br />APPLICANT'S SIGNATURE X <br />LJ PACKAGE PLANT <br />❑ OTHER <br />Where Certified <br />In and te ork will be done in accordance with San Joaquin County <br />the San aq ,Local Health District. <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 />BASE EXPLANATION BILLING <br />REMITTANCE <br />$ AMOUNT DUE <br />CHECKED <br />DATE <br />DATE <br />REMITTED <br />AMOUNT <br />FEE <br />��/p <br />�M <br />BOO• Q <br />LESS <br />PRORATION <br />PLUS <br />PENALTY <br />(0 770 <br />OTHER <br />ETHER <br />V <br />Received by Date Receipt No. Permi[ No. Issuance.Date Mailed Delivered <br />............. ...-,.e..., , rre,...— cu.,,onuucur., uc., r....u.r.m...,rc. ..,,. c uerm mu arc en e... ame emrrrnu re xvm <br />