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DBA �• flit.!i i 1 r <br /> r�Ut ,-�ADDREss <br /> ADDRESS C' �, �— <br /> ,� a <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. IgS-7 �W&- <br /> b. Additional Tanks N Additional Tanks x $50) ' <br /> 2. State Surcharge (per tankPermit <br /> } (Due with Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N Tanks) <br /> 3• `Temporary Closure <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (# Temporary closures x $80) (See above 13 to calculate surcharge) <br /> 4 . Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of rre-using tank , ` <br /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. SEG M�Nr <br /> r via <br /> AUG P - 8g <br /> ZOO Pen <br /> Total Number of Tanks <br /> �A4� ft Due <br /> Jo <br /> Make all fees payable to San Juin Local Health District. Enclose this worksheet <br /> with your check <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />