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Applications Will Be Procet When Submitted Properly Completed. Be Sure To gn The Application. <br />SAN JN LOCAL HEALTH DISTRICT GENERAL <br />ENGINEER'S AND/OR APPLICATION IF VEHICLE INVOLVED, GIVE <br />APPLICANT'S AND/OR Make <br />'CONTRACTOR AND/OR ENVIRONMENTAL HEALTH PERMIT/SIERVICIES <br />BROKER AND/OR Lic. No. <br />LICENSE AND/OR FOOD ESTABLISHMENTS, HOUSING Regist. No. REGISTRATION PUBLIC POOLS. WATER SAMPLING —. <br />NUMBER REAL ESTATE INSPECTIONS Color <br />POULTRY RANCHES AND KENNELS <br />MISCELLANEOUS SERVICES <br />F Application Date Business/Name To Appear On Permit B & C Construction Company <br />jaType Permit/Service Requested: Waste Oil Tank Removal <br />I Applicant Name B & C Construction OD—MPAny—Address 5637 N Pershing. A-3 Stockton 95207 <br />2 Business Telephone No. -(2091--9-51 -9 304 Emergency Telephone No. 1209 9 304 <br />9 <br />5 Property Location/Address 341 E. Main. npon,_ California - <br />d Property Owner Shell Oil Company— Address Sa ramento, California <br />L Operator's Name Address <br />1. FOOD ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity <br />0 RESTAURANT 0 FOOD MARKET RETAIL 0 FOOD MARKET WHOLESALE 0 MEAT MARKET <br />0 FOOD PROCESSING PLANT 0 COMMISSARY 0 ICE PLANT 0 BAKERY <br />0 ROADSIDE FOOD STAND 0 LIQUOR STORE 0 BAR 0 ITINERANT RESTAURANT <br />13 CONFECTIONARY STORE 0 FOOD SALVAGER 0 FOOD DEMONSTRATION 0 FOOD VENDOR <br />0 VENDING MACHINES/No. of 0 MOBILE FOOD PREP. UNIT 0 VENDING VEHICLE <br />0 FOOD CROP HARVESTING/No. of Field Employees <br />ALL APPLICANTS: Total Employees Including Operators <br />2. HOUSING <br />13 HOTEUMOTEUNo. of Units 13 CERTIFICATE OF OCCUPANCY <br />0 MOBILE HOME PARK/No. of Spaces — <br />3. WATER QUALITY 13 WATER SAMPLE (Bacterial) 0 CHEMICAL <br />11 PUBLIC WATER SYSTEM 13 SURFACE WATER SUPPLY 13 WATER HAULER <br />NO. OF PUBLIC SERVED (Connections) <br />4. RECREATIONAL HEALTH 13 SWIMMING POOL 13 SPA 0 WADING POOL 0 NATURAL BATHING PLACE <br />S. VECTOR CONTROL 13 POULTRY FARM/Maximum No. of Birds — <br />E3 KENNEURunways — /Animal Population No. No. of Confining Cages <br />Sewage Disposal Method <br />Solid Waste Disposal Method <br />,g Water Supply Source Animal Waste Disposal Method <br />B. 0 CONSULTATION FEE <br />13 BUSINESS LICENSE <br />7. 13 PLAN CHECKING FEE 0 DANCE PERMIT <br />8. REAL ESTATE <br />REQUEST: Water Well Inspection 13 Sample[3 Title Company <br />Sewage System Inspection 0 Address Tale. 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, state laws, and rules and regulations of the San Joaquin Local Health District. <br />APPLICANT'S SIGNATURE X_ kmri�M Title Partner Date 3-11-85 <br />FOR DEPARTMENT USE ONLY <br />Fee Is Due: 0 ANNUALLY 0 PER UNIT 0 PER SITE 0 EACH 0 january 1 & Received By January 31 ❑ July 1 & Received By July 31 <br />Received by Date <br />APPLICANT—RET TO:.. <br />Receipt No. Permit No. <br />IONNIENTAL HEALTH PERMIT/SERVICES loci <br />L I dommult..- <br />6 ce Date Mailed Delivered <br />LTON AVE., P.O. Box 2009 STOCKTON, CA $5201 <br />i <br />0 <br />0 <br />REMIT <br />BASE <br />EXPLANATION <br />BILLING REMITTANCE' <br />$ <br />AMOUNT DUE <br />CHECKED <br />DATE DATE <br />REMITTED <br />AMOUNT <br />FEE <br />LESS <br />PRORATION <br />PLUS <br />170� <br />PENALTY <br />OTHER <br />OTHER <br />Received by Date <br />APPLICANT—RET TO:.. <br />Receipt No. Permit No. <br />IONNIENTAL HEALTH PERMIT/SERVICES loci <br />L I dommult..- <br />6 ce Date Mailed Delivered <br />LTON AVE., P.O. Box 2009 STOCKTON, CA $5201 <br />i <br />0 <br />0 <br />