COMPLIANCE INFO_1974-1992 - Laserfiche WebLink

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Property Location/Address __. Austin__Road�Forwarti_Landfill iProperty Owner - - ---- --- - - - Address - - -- -- - - - — - --- ---- [ Operator's Name _ _ _ _- _-------------.------_--..-_-_ -_- --_-. Address 1. FOOD ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity ❑ RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY ❑ ROADSIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT ❑ CONFECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR ❑ VENDING MACHINES/No. of _______._..____ _-___ _ __ _ ❑ MOBILE FOOD PREP. UNIT ❑ VENDING VEHICLE ❑ FOOD CROP HARVESTING/No. of Field Employees ALL APPLICANTS: Total Employees Including Operators 2. HOUSING ❑ HOTEL/MOTEL/No. of Units ___ _-______ ❑ CERTIFICATE OF OCCUPANCY ❑ MOBILE HOME PARK/No. of Spaces 3. WATER OUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER NO. OF PUBLIC SERVED (Connections) ._________ 4. RECREATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE 5. VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds __ _ ____ - .ENNEL/Runways _.. _ _ /Animal Population No - _ __.._ _ -_ No. of Confining Cages Sewage Disposal Method Solid Waste Disposal Method — -- _ Water Supply Source _ _ _-__._ Animal Waste Disposal Method 6. ❑ CONSULTATION FEE 7. ❑ PLAN CHECKING FEE — --- 8. REAL ESTATE REQUEST: Water Well Inspection ❑ Sample ❑ Title Company Sewage System Inspection ❑ Address __ _._....... __ _-_ Tele. No. Escrow No. Seller _ _ _ _ __ __ _ _ __ _____-__ Seller Address --------. __--._ -- -- _--_ _. _--------_._-- Telephone No - _. _ -___ ___� Seller Agent Name Service Request For Date I,hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, state laws. APPLICANT'S SIGNATURE X ___---- --_--------_------_._-___ _---_--. _.___.___- Title ..____-_------------- Date FOR DEPARTMENT USE ONLY Fee IS Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 & Received By January 31 ❑ July 1 & Received By July 31 FEE LESS PRORATION PLUS PENALTY OTHER OTHER BASE _ $154.n $15.90 Applications Will Be Pro sed When Submitted Properly Completed. Be Sure Sign The Application. BILLING DATE Work -pi APPLICATION $ REMITTED AMOUNT DUE REMIT CHECKED AMOUNT ENVIRONMENTAL HEALTH PERMIT/SERVICES ENGINEER'S ANO,OR IF VEHICLE INVOLVED, GIVE APPLICANT'S AND/OR FOOD ESTABLISHMENTS, HOUSING Make C DNTRACTOR AND/OR PUBLIC POOLS, WATER SAMPLING - - BROKER AND/OR REAL ESTATE INSPECTIONS Lic. No.-__- irENSE AND/OR POULTRY RANCHES AND KENNELS Regist. No. g 3TRATION MISCELLANEOUS SERVICES -- .dER _ Color --------------- - -.. - Application Date Business/Name To Appear On Permit Type Permit/Service Requested -- _ - 1`_ 29Applicant Name -_ Spectrum/Kl_einf elder_- - Address 2825 E. Myrtl.e.Stree_t,__Stockton,__OA g _ 9520.5__. _ .__ ______-- _. Business Telephone No. __ ____ __-__ _ Emergency Telephone No. Property Location/Address __. Austin__Road�Forwarti_Landfill iProperty Owner - - ---- --- - - - Address - - -- -- - - - — - --- ---- [ Operator's Name _ _ _ _- _-------------.------_--..-_-_ -_- --_-. Address 1. FOOD ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity ❑ RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY ❑ ROADSIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT ❑ CONFECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR ❑ VENDING MACHINES/No. of _______._..____ _-___ _ __ _ ❑ MOBILE FOOD PREP. UNIT ❑ VENDING VEHICLE ❑ FOOD CROP HARVESTING/No. of Field Employees ALL APPLICANTS: Total Employees Including Operators 2. HOUSING ❑ HOTEL/MOTEL/No. of Units ___ _-______ ❑ CERTIFICATE OF OCCUPANCY ❑ MOBILE HOME PARK/No. of Spaces 3. WATER OUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER NO. OF PUBLIC SERVED (Connections) ._________ 4. RECREATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE 5. VECTOR CONTROL ❑ POULTRY FARM/Maximum No. of Birds __ _ ____ - .ENNEL/Runways _.. _ _ /Animal Population No - _ __.._ _ -_ No. of Confining Cages Sewage Disposal Method Solid Waste Disposal Method — -- _ Water Supply Source _ _ _-__._ Animal Waste Disposal Method 6. ❑ CONSULTATION FEE 7. ❑ PLAN CHECKING FEE — --- 8. REAL ESTATE REQUEST: Water Well Inspection ❑ Sample ❑ Title Company Sewage System Inspection ❑ Address __ _._....... __ _-_ Tele. No. Escrow No. Seller _ _ _ _ __ __ _ _ __ _____-__ Seller Address --------. __--._ -- -- _--_ _. _--------_._-- Telephone No - _. _ -___ ___� Seller Agent Name Service Request For Date I,hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, state laws. APPLICANT'S SIGNATURE X ___---- --_--------_------_._-___ _---_--. _.___.___- Title ..____-_------------- Date FOR DEPARTMENT USE ONLY Fee IS Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 & Received By January 31 ❑ July 1 & Received By July 31 FEE LESS PRORATION PLUS PENALTY OTHER OTHER BASE _ $154.n $15.90 EXP ANATION oiLBor-in enalty BILLING DATE Work -pi REMITTANCE DATE $ REMITTED AMOUNT DUE REMIT CHECKED AMOUNT --__-- $174.90 Received by Date Receipt No Permit No Issuance Date Mailed Delivered - APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E. HAIELTON AVE., P.O. Box 2009 STOCKTON, CA 95201