HomeMy WebLinkAboutUST APP (2)BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
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101 H Street
PERMIT APPLICATION 25
n Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW FIRS Phone: 661- 326 -3979 a Fax: 661- 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD aBtm r
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Permit #�
TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
CHECK ONE ONLY ❑
MODIFICATION OF FACILITY
MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED CONIPLERON DATE
FACILITY NAME
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EXISTING FACILITY PERMIT #
FACILITY ADDRES� ` %
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ZIP C
TYPE OF BUSINESS
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APN #
TANK OWNER
PHONE #
ADDRESS
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ZIP
CONTRACTOR
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ADDRESS.n
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ZIP
LICENSE #'
'IAfO�Ift�IANS CAMP # ;
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09)