Laserfiche WebLink
`� •• ��• Trea rropeny L:omplerea. tie burre`lo bign the Apprlcanon. <br /> APPLICATION <br /> Non-Transferable, Revocable, and Suspendabl <br /> olo'ENVIRONMENTAL HEALTH PERMIT SEPTAGE <br /> LIQUID WASTE <br /> Application is hereby made to carry n business in the jurisdictional area of the an Joa uin L ealt ist 'ct <br /> Business Name (DBA) valley Mechanical Inc. P.O. �ax ` 9 f 95205 <br /> a Owner George J. Fleck Address oc tan <br /> Address 606 Reid Linden CA <br /> Firm Partners, Addresses and Telephone Numbers -- <br /> aBusiness Telephone No. 1-40 1 <br /> �Contractor Licence No. <br /> 333319 Emergency Telephone No. <br /> Applicants Name (Print) Mel Thweatt IT <br /> Title Estimator 12_1_ 0 } <br /> Please check Applicable Category (1-7)and Fill in the Required Information Date <br /> I. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) �J <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 /> Capacity Gal.,Weights &Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> 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. IE SANITATION PERMIT <br /> Job Address/Location 10100 W. Linne Road Tracy, CA g 76 <br /> Owner AMERON Pi Division Northern CAL Address P.O. Box 713 Tracy, CA 95376 <br /> a SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> I1 PERMANENT ❑ TEMPORARY NEW ❑ REPAIR ❑ OTHER <br /> 5. ❑ CHEMICAL TOILETS For July 1, -June 30, 19 SEPTIC 'BANKS — 1200 GALLONS EACH� <br /> Type Construction Disposal Site with 100' leach line C� <br /> No. of Units Equipment Storage/Cleaning Location(s) 2 SEPTIC TANKS — 1600 GALLONS EA <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 with 300' leach line <br /> Operator Name Where Certified C�) <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 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules and regulations of the San Joaquin Local Health District. <br /> APPLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January Received By January 31 ❑ July 1 &Received By July 31 <br /> BILLING REMITTANCEPPir $ REMIT <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNTDUE CHECKED <br /> AMOUNT <br /> FEE /1( o <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> cFD , <br /> Received by Date Receipt No_ Permit No, Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Boa 2009 STOCKTON,CA 95201 <br />