Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH AI9TRICT <br /> IDERGROUND STORAGE TANK PROGRAM - FEE VORKSH6. <br /> F FACILITY/SITE NAMF FACII-ITY CONTACT NNApME <br /> A Pescadero Reclamation District #2058 Wendy Ke11y—Pescadero Recla— <br /> C mation 2058 <br /> L STREET ADDRESS SITE PHONE 1 (with Area Code) <br /> T 3600 W Canal , Tracy CA 95376 <br /> �h <br /> Y CITY Trac CA 95376 ISrTEI� 1 of TANK'S one under round <br /> Y CA at Site g <br /> ---------- -. t.nraee tank <br /> A APPLICANT/BILITG APPLICANT CONTRCT NAME <br /> P Pescaero Reclamation District *2058 <br /> P Wendy Kelly <br /> L -- - <br /> I MAILING DOG ESS / APPLICANT PHONE 1 ruith Area Code) <br /> N CITY/ STATE ZIP CODE - TYPE of APPLICATION <br /> I r Vic= �� ' 76 'Closure, Installation, etc. Closure <br /> A S O RECLAMATION 4333 <br /> DI <br /> C DISTRICT <br /> NO. 2058 <br /> I 3650 W. CANAL 209-835-2293 <br /> d. <br /> V _ -3F3 19 <br /> E <br /> PAY TO THE ���, )Q�a�) /1 1 � L,_�.�, i I $ <br /> F ORDER OF �;n N 1 fl 1 'Yt <br /> A <br /> 1 N1Q���l1fS /XX DOLLARS Pd' <br /> I �WESTSIDE BANK PESCADERO RECLAMATION DISTRICT NO. 2058 <br /> I WW 10TH ST.TRACY,CA 9SI76 <br /> Y <br /> L ? <br /> !� <br /> 5 CLOSURE FEE = 110.00 each TANK an s_ x f_ 9 V—.Vv <br /> U _ <br /> E TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> TEMPORARY CLOSURE FEE _ $80.00 each TANK 1 Tanks R $80.00 f <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A <br /> N PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUBMISSION 1 <br /> R REPAIR <br /> P TANK REPAIR FEE = 1110.00 each TANK t TanksR $110.00 1 <br /> A <br /> I PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION ISAMPLING <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE _ (35,00/hr FEE _ $35.00/hr $ <br /> TOTAL DUE f <br /> OFFICE USE ONLY <br /> SWEEPS 1 COMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK /CASH RCVD BY I DATE RECEIVED PERMIT t <br /> i3y <br /> IAL'&361 ay I � 433.3 -�- <br />