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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> ,- - (For Non-Transferable, Revocable, and Suspendable) ` <br /> ENVIRONMENTAL HEALTH PERMIT SEPTAGE ✓ <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> OF Business Name (DBA) World Enterprises , Inc. Address P * 0* Box 8598, Stockton _95208 <br /> z Owner Address <br /> u Firm Partners, Addresses and Telephone Numbers �� + <br /> CL <br /> Business Telephone No. 931-2974 Emergency Telephone No. 466-0717 a <br /> Contractor Licence No. 26 59 64 <br /> Applicants Name (Print) Donald Lawley Title —Fresdent- DateMay 28 1980 - M <br /> Please check Applicable Category(1-7)and Fill in the Required Information 4- <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) r <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 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 /> 4 <br /> No. of Chemical Toilets Stored <br /> 3. 0 PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. t <br /> Test Location Test Date/Time + <br /> 4. ❑ SANITATION PERMIT t..1 <br /> Job Address/Location 326- S. Madera, Stockton <br /> Owner California Cidar ProductsAddress 1340 W. Washington, Stockton Ca. <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT 0 PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR MCOTHER Septic Tank Removal <br /> 5. ❑ CHEMICAL TOILETS For July 1, -June 30, 19 <br /> Type Construction Disposal Site <br /> No. of Units Equipment Storage/Cleaning Location(s) y <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> Operator Name 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., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <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 d regulations of t S Joaqui Local Health District. <br /> APPLICANT'S SIGNATURE X <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 /> BILLING REMITTANCE $ REMIT <br /> BASE EXPLANATION AMOUNT DUE CHECKED <br /> DATE DATE REMITTED <br /> AMOUNT <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS .� <br /> PENALTY <br /> OTHER <br /> OTHER <br /> 3.35 <br /> Received by f Dat Receipt No. Permit No, I ssuarke Date Mailed Deliver d I <br /> t APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Box'2009 STOC TON,CA 95201 <br />