Laserfiche WebLink
b; r ransmiftai <br /> t <br /> A\ <br /> i%amo <br /> Eliminates Cover Sheets-Saves You Money! <br /> a � UV <br /> U FOOD CROP HARVESTING/No. of meta tmployees <br /> ALL APPLICANTS: Total Employees Including Operators . <br /> 2. HOUSING ' <br /> ❑ HOTEL/MOTEL/No. of Units ❑ CERTIFICATE OF OCCUPANCY <br /> 13 MOBILE HOME PARK/140.of Spaces <br /> NATER QUALITY ❑ WATER SAMPLE (Bacierial) ❑ CHEMICAL <br /> PUBLIC WATER SYSTEM Q SURFACE WATER SUPPLY ❑ WATER HAULER <br /> NO.OF PUBLIC SERVED (Connections) <br /> a. R_CTIEATIONIAL HEALTH ❑ SWIMMING POOL ❑ SPA 0 WADING POOL 0 NATURAL BATHING PLACE <br /> ( 1SCTOR CONTIOL ❑ POULTRY FARM/Maximum No.of Birds <br /> KENNEL/Flunw•aya !Animal Population No. No.of Confining Cages _ <br /> Sowcge Disposal M—Ihcd <br /> Solid Waste Disposal Mo:hod _ <br /> Water Supply Source r Animal Waste Disposal Method <br /> B. CONSULTATION FEE TT.= r r•�`"'.-�. :� ,•r, - `� S 0 BUSINESS LICENSE <br /> T. PLAN CHECKING FEE , r ❑ DANCE PERMIT <br /> 6. REAL ESTATE , <br /> REQUEST: Plater Well InspactionO Sample❑ Title Company <br /> Sewage System Inspection O Address Tele. No. <br /> Escrow No. - <br /> Seller Seller Address <br /> Telephone No. Seller Agent Name. - <br /> Service Request For Date <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,stale laws,and rules and regulations of the San Joaquin Local Health District. <br /> APPLICANTS SIGNATURE IXFOR DEPARTI.ENT USE ONLY <br /> Fee Is DUB: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 6 Received By January al, •. IJ I�t �.h��f�PI� Jvly al <br /> BILLING REMITTANCE $ } .' Z REAfIIT <br /> BASE EXPLANATION .DATE DATE. REMITTED f' AMOUNTOUE 'LIIE99KED <br /> All.pl2NT - <br /> FEE OCI ,I <br /> LES _ ,. .. <br /> PRORATION <br /> PLUS <br /> PENALTY !\I 1.'1 — <br /> ,1 -. <br /> OTHER <br /> 1 OTHER <br /> t necciv.J-0y D91v n:cnn:'u Pr-n iuo Isiunn[�DaV MeilOd Dlbvered ,r <br /> -—LPPUCANT—f.'TLJ:3L.L=Z-70: c.........._:]!1TAL E:E:LTH PE fi'lIT'iEnvICE: IWI E.HAZELTOH AVE..P.O.S*a 2000 S1 OCn TON,CA 93201 — - <br />