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82-71
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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10300
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4200/4300 - Liquid Waste/Water Well Permits
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82-71
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Last modified
11/19/2024 1:53:40 PM
Creation date
12/3/2017 4:23:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
82-71
STREET_NUMBER
10300
Direction
N
STREET_NAME
STATE ROUTE 99
City
STOCKTON
SITE_LOCATION
10300 N HWY 99
RECEIVED_DATE
02/23/1982
P_LOCATION
NORTHSIDE FREEWILL CHURCH
Supplemental fields
FilePath
\MIGRATIONS\N\99 (HWY99)\10300\82-71.PDF
QuestysRecordID
1879087
Tags
EHD - Public
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I ApplicationsWI 11 Be Processed When"Suibmttied Properly Compleled. Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Nan-Transferable,'Revocabfe�and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT SEPTAGF <br /> uipum wasrE <br /> ApIBA) on is hereby made to p rry o busines in the lurid'ctional area of the San Joaquin t- cal H altfa District. 4 <br />*- y Business Name (DBA) L - <br /> a OwnerQL <br /> Address, <br /> Address <br /> Firm Partners, Addresses and le o e Nu bers <br /> 0. Busihess Telephone No. <br /> Contractor LicenceNo. G"' Emergency Telephone No. <br /> LApplicants?Name (Pririt)' r ... <br /> Title at <br /> Please check Applicable Category,(1-7) and Fill In the Required Infvrrnation � y <br /> �.,f1. � PUMPER VEHICLk PERMIT`REGISTRATION(FOR EACH VEHICLE) "a <br /> For July 1,- f -.i June 3p, 19 Disposal Sites <br /> Description(Make/Yr.,Color) <br /> Serial No. CAL. License No. f _ter .CAL.""'License Renewal No. 1 <br /> Capacity` t {. _., <br /> " _GaL-Weights &-Measures No. -^�-- - ---- — <br /> Equipment Parking Address <br /> 2. ❑ PAMPER YARD _ -4..• ; <br /> For July 1, June 30, 19 <br /> No.of Vehicles Stored f ' <br /> No. of Chemical Toilets Stored ( s <br /> 3. ❑ PERCOLATION TEST E <br /> i <br /> R.S.:or R.C.E. Name s • , 1 r w R:S. or R.C.E. No. <br /> Test Location O <br /> Test Date/Time i S <br /> 4. SANITATION PER T <br /> Job sAddres /Location ( - ` t <br /> f r <br /> Ow_vier } ,� r <br /> SEPTIC TANK ❑ CESSPOOL t+ - <br /> LEACHING FIELD SEEPAGE PIT ❑TPACKAGE`PLAtVT >< <br /> ❑ PERMANENT ❑ TEMPORARY NEW `❑\ " <br /> REPAIR ❑'OT4EF31' ] /," ',,� T t <br /> 5. ❑ CHEMICAL TOILETS For July 1,'-June 30, 19 1 ! <br /> Type ConstructionDisposal-Site <br /> No. of Units ! <br /> Equipment Storage/Cleaning Location(S), <br /> 8.? ❑ PACKAGE TREATMENT PLANTFor July 1, -June 30, 19 <br /> i a - <br /> Operator Name Where Certified f � <br /> P.larit Location y <br /> s <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 3 1 } <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft' t1 r y <br /> DRY CLEANING, Chemicals Used/Amount/Mo. .3 a <br /> lfomeowncrarllcensertagratYs?ig�._i,racertF=Wsthesofiewtng:"Irerfifytht rrthegerfermar�ceofthewor.'ffohwhichthispermitisas,ued,tshellnoremployanypersnn <br /> •ln s ch manner as hecome s bject to v�i?rxs,lan'g cnm;,efisatiar,!aus o#Calilntnia."r ) <br /> C6piuy pores sirup, or seri-contract-, s gr,a:,r .rerii;.es the fot#awing: 'Tris rtify 1AI in tre perform�ancE of the v,,urk for whsch this permit isJssueQ f shall <br /> trrpie; pefsflns;uhject,o�vcrkman's coli l i a+nn;"r.s cf California." 1 � ((( <br /> r"! I hereby cel'tify t I have prepared tII application and thaf the work ill be done iniaccordance vuithj San Joaq in County � <br /> ordinances, state laws, d rules and reg leI" s•-of-the an Jo uin Local Health District- <br /> ,• <br /> ARRLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE:ONLY'��"`r¢s " <br /> i <br /> Fee IS[Due: ❑ ANNUALLY PER UNIT. ❑ PER SITE ❑ EACH ❑ January 1 8&Received By January 31 ❑ July 1 &Received By July 37 <br /> I BILLING REMIT <br /> 'RASE EXPLANATION REMITTANCE $ <br /> DATE AMOUNT DUE <br /> DATE REMITTED CHECKED- AMOUNT <br /> FEE <br /> f <br /> T�'+ <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY V J <br /> OTHER <br /> 4r <br /> �. OTHER <br /> Received lay Date Recei t No. _ <br /> P Y, Permit'No} 4rlssuance Date Mailed Delivered <br /> URN ALL COPIES TO: "ENVIRONMENTAL HEALTH PERMIT/SERVI <br /> APPLICANT—RETCES ,'' <br /> t601'E.HAZELTON AVE„P. .OBox 2009 STOCKTON,CA 95201 <br /> � I <br />
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