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�f Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign TheApplication <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 /> H Business Name (DBA) World Enterprises , Inc. Address P• 0• Box 8598, Stockton 208 —: <br /> z Owner Address <br /> a <br /> Firm Partners, Addresses and Telephone Numbers <br /> a Business Telephone No. 931--297 _ Emergency Telephone No. <br /> 466-0717 <br /> Contractor Licence No. 26 64 <br /> Applicants Name (Print) Donald Lawleyy 3 'z`�"1 Title P ld Date� � l80 1 f <br /> Please check Applicable Category (1-7)and Fill 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 /> I <br /> Capacity .- Gal„Weights & Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> I 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 R.S. or R.C.E. No. —•, <br /> Test Location Test Date/Time <br /> 4. ❑ SANITATION PERMIT . <br /> Job Address/Location 28 S. Van Buren, Stockton, Ca. <br /> Owner California Cedar Products Address 1340 W. Washington, Stockton, Ca. <br /> I� ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT R rC <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR KKOTHER 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) n <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 prepare this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules a rions oft S quinL al Health District. <br /> APPLICANT'S SIGNATURE X hCO <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT PER SITE ❑ EACH ❑ January l &Received By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE (/ <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY - <br /> OTHER dRUMOMMUMMO <br /> OTHER <br /> Received byDate ,� Receipt No. Permit No. - Issu aft Date - Mailed Deliv d <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES _1501 E.HAZELTON AVE.,P.O.Box 2009_ STO TON,CA 95201 <br /> rR= <br />