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lug- 18-99 02 : 48P COS rTMit� cent.iar 2037 8893 P . 02 <br /> City of Stockton <br /> Fire Prevention Division <br /> fry 345 North El Dorado Street <br /> Stockton, CA 95.202 <br /> 1`209) 937-8271 <br /> F. <br /> PECIAL W PECII ON APPLI CATIQN <br /> City County ❑ <br /> Permit No. Date <br /> Application is hereby made for a permit/special inspection as required by the Stockton Municipal Code: j <br /> FAn-/Sec(s) Permit(s) Feels) <br /> FUNDERGROUND TANK REMOVAL $200.00/PER TANK <br /> t . Comments: Total Fee: 2 0 0 <br /> JOB SITE INFO: <br /> Business Name__ <br /> Address 4ol Sou�� 5k Ste. Zip <br /> f • Telephone T _ <br /> Contact Person_KnV1 i _B ass o Telephone <br /> CONTRACTOR INFO: II 11 <br /> Billing Address 3137 cas�Yn Vq II 1-dA, 4 2 0 q <br /> c ls�yo V q II `?4-S`�- � Telephone ( -101 2-4 q <br /> City/alp P <br /> F1 have read the above application and know the cont©nts thereof; the same is true and correct. ! further state that <br /> l am familiar with accepted fire protection and prevantinn practices as set forth in the City of Stockton Uniform l=ire <br /> F. Code, and the amendments thereof, and use of the permit being applied for will conform to these practices. <br /> fi6Appticant's Signature: �� Code: 5-A Ck## Z(00 0 <br /> F Amt. <br /> Inspected/issued by: <br /> FiDate Issued: <br /> T:tiVIRFPREV%FORMSNPERMI rS.WF10 <br /> White: t=ile Yellow_ Fire CO. Goldenrod- ChPr.k C;rpan- FPf) Pir,tr• riicin^+— <br />