HomeMy WebLinkAboutMajor Mod Permit App 7-5-16UNDERGROUND STORAGE TANK
PERMIT APPLICATION FIR0
TO CONSTRUCT-INSTALL NEW TANK NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
.......... .. .. .. . . . ..................
Permit
0000
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 9 Fax: 661-852-2171
Page 1 of 1
❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) 'MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
FACILITY NAME
?1i EXISTING FACILITY PERMIT #
FACILITY ADDRESS CITY ZIP CODE
Ll go C
rTYPE OF BUSINESS APN #
I WATER TO FACILITY PROVIDED BY
I DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
MAILING ADDRESS
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NAME OF TESTER ICC#'
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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FD2086 (Rev 11/2015)