HomeMy WebLinkAboutOPI APP 2.4.19UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(C_Ht:C K UNL UNLY)
❑ MUDIFICATIUN OF FACILITY
❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
FACILITY NAME
EXISTING FACILITY PERMIT#
FACILITY ADDRESS q Lo
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CITY ' -,.
ZIP
q ,
TYPE OF BUSINESS . �
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APN #
TANK OWNER ._._
PHONE #
ADDRESS
CITY
ZIP CODE
.CONTRACTOR �'
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C'sA LI� S�
ICE
ADDRESS
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CITY`
ZIP
PHONE #
BAK ,S1aI C�1T, US__INES_ S E #
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BRIEFLY DESCRIBE THE WORK TO BE DONE: