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App.r.anon Will Be Pror:n•snd w�.n 5ubmmeo Property COmpht•d e• tu.. To Sign The Apalwinlon <br /> APPLICATION <br /> (For Non Translsrabll,I IVOCaCM and Suspsndoble) <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> AppI.cat,on.shnrr ny—,id, .'n „�..,-•r banal arwa M MA An joan'en LnCAf el'08"n 01`0..r <br /> n Business Name IDRA) D. q n'r1 rZ,, Addrns / 'p' �w l�'Q7 Sf•tN %)`2•:P <br /> i Owner <br /> Form Partneri. Addresses and Tnb.pnnnn Ir.,r., •- <br /> a Business Telephone No N6 G-9 60 7 Ern•rp•nr y Tw••Prionl No <br /> �Contractor Licence No 25'Y- 3 °/3 AA- <br /> ` ApplicantsName(Print) ir, 4 �' •" ���Cf/ 1.1101O� �d_� O it. <br /> Phew chill ApplleabN Calegorf,11.71 and rill In In, bVbYa17RIMIMM <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION(FOR EACH VSHICLE) <br /> For July 1, June 30, 19 Onposal Snas -- n <br /> DesOnptlon(MakoiYr.,Colon ` <br /> CAL L <br /> Serial No. r.nLK•nw NO. _ ttAMM MMIFr NO y <br /> Capacity fel W.,q.n. A Messuraa NO .".._. _- ,...._,.... .-. <br /> Equipment Parking Address - --- <br /> 2. V PUMPER YARD <br /> For July 1... June 00 Ili <br /> No.of Vehicles Slorwd <br /> No of Chemical TOde16 ilornn <br /> 0. 13 PERCOLATION TEST <br /> R.S.or R.C.E.Nara as Or R G E tw <br /> Test Location - TNI Dam/T~ <br /> A. B SANITATION PERMIT a� <br /> Job AddreesRncatlon / 1 y8 /'/• Tlfc&SAW <br /> Owner _,✓u't•ve S'wa 'sC.: Address <br /> SEPTIC TANK 13CESSPOOL jtE•• I n(...i'+O FIELD ,% SEE►AOE PIT O PACKAGE PLANT .,.� <br /> PERMANENT O TEMPORARY V NI N O REPAIR Q OTHER Z, <br /> S. ❑ CHEMICAL TOILETS For July I " r <br /> Type ConstruCti0h __ D'si.osal SnI _ _ _ '•`�� <br /> No. of Units . - F-I..•........ ... ,af e,C~,nq Lo ,onjsl _ <br /> b. 0 PACKAGE TREATMENT PLANT r •. i,, , i Juns 30 19 <br /> ~CaErar <br /> Operator Name <br /> Plant Location _. <br /> Plant Capacity. _ No units so <br /> e 7. O LAUNDRY For July 1,-Jun 70 I <br /> SIZE u Less Than 1,000 Sq Ft. C3 ... I r':i" 1 000 Sq Ft n <br /> C3 DRY CLEANING,Chemicals Uwdumc.„'' n•11 t - <br /> ` it. w61e'ILI✓N1.NF MFa'y 1u. ....a. /�` <br />' KM'II OL•1111 MII.wn11'I YrI„^' '. , vw <br /> kl:cta len-lest u. .. ...,.•AL♦�...n..r1 • r.M v:.yai <br /> m CMnnetol'l hui•q 01 . •• ' '• <br /> S• r•ro .VVIIUUUU .nJ Inst the wUrA WO b.doli• N"C440Yita 04%Vn leWien CA00 a <br /> 1 hereby certify that 1 navy V'rr' <br /> Ordinances.state laws.and 1w,” u^J IV,)yj/oon c San Joaq� Mi 0”. wt ` <br /> 41 APPLICANT'S SIGNATURE �"�� <br /> FOR DEPARTIKNT NSE OIILY <br /> Pw Is OW.Q ANN'.t i. ❑ v-. 131m-N QA ,Aiikw + A .r-�••.I• Q .n•sr..rMn,.• n <br /> Wool <br /> ww"A.a:s 1 AsroLysr lAe ce1caae <br /> II.11 O.TE at 1.••Lr. c •.aa, L J <br /> USS <br /> MOR.TION <br /> PLUS <br /> "NALT4 <br /> "'ER <br /> pO•!N /) � <br /> /r 4 �,t /•il ! i�-I..J��-j OXY-' �iE.. � L�AfrJIi <br /> Ret^.'r+10. ,.. .., i�•. Ow w.w ice.... 7 <br /> JMICANT-RVTURN ALI C0111 IO r., .u.41a Nr\LTi.rRY118rnar 11 rM11 NAIILTON A" Po WMO alOtatOa Ca YI <br />