Laserfiche WebLink
d <br /> SAN •AGIUIN LOCAL HEALTH DICT <br /> b UNDERGROUND STORAGE TANK PROGRAM - FEE NORKSHEE______1 — <br /> FACILITY CONTACT NAME <br /> IF 'FACILITY/SITE NAME W <br /> r <br /> i �``�> �—'�—� SITE PHONE 1 WITH emu eomm <br /> L STRE IiDQRE S =49SV <br /> _ �_ `Tt�o t�_-. D� <br /> T — STAT .TIP CODE 1 of Tanks / n� <br /> YCITd\T ' tp� at Site <br /> `� �— APPLICANT CONTACT NAME <br /> A APPLICANT/BILLING NAME <br /> P <br /> L � APPLICANT PHONE 1 WITH ARIA eoom <br /> I MAI MG AD �SS T Q� — 6 — g�� <br /> r _U . S�SL -- — <br /> A STS iIPP GOOD APPLICATION t <br /> . CIT �J goo a PLICATe*roY, ere <br /> ------- TOTAL <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br /> A _-.....__..—_._.._..._...___.--.-- <br /> C 1986 1981 1988 1 — <br /> T s _ <br /> 1 <br /> V __.._.. <br /> E TANK FEE x 150.00 each TANK _ --- <br /> 1986 1981 1988 1993 �.. <br /> T 1 Tanks __ _ x 550.00 �� <br /> A (multiply 1 by fee for 1 — <br /> C each year applicable) —� <br /> I ---- applicability) -- — <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH k SAFETY CODE Sec 25281 tot <br /> f 1 Tanks a $56.00 1986 1981 1988 <br /> Y (enter aiount and year) f _ <br /> C, PERMANENT CLOSURE (Removal or Closure-in-place) -- <br /> L------------ ----- — 1 Tanks z 190.00 1 <br /> 0 CLOSURE FEE = $90.00 each TANK I <br /> S _ — <br /> tU -- —--- --_ <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) —_— <br /> E --- -- --------------- 1 Tanks— x 580.00 1 <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK � ------_—_—__—.—_ ---— <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A1 <br /> M PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMISSION —__------- <br /> _ <br /> REPAIR ....... <br /> _._—._— --- ------ ------- 1 Tanks------ % 1110.00 1 <br /> R TANK REPAIR FEE = 1110.00 each TANK <br /> P._.. _ ---__-....__.. ----- — ---- --------- <br /> A PIPING REPAIRICLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) --__ <br /> I ——...—-- — — -------- <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING <br /> Iilca6lejON <br /> (when applicable) (when applicable) pP —__,.._..___.............. <br /> — - 1 <br /> FEE = 135,00/hr <br /> FEE k30.00Ihr FEE = f35.00/hr -- <br /> ---. TOTAL DUE t <br /> OFFICE USE ONLY IST CODE AMOUNT OU AMOUNT RCVD CHECKI/C�ASH RCVO BY DATE RECEIVED PERMIT 1 <br /> SWEEPS 1 COMP 1 . LOC COOED ---- <br /> -._. .. _ o� 777 <br />