Permit Information
Permit Information
| Is this application for a New or Existing Permit (Renewal)? |
New
|
Facility Information
| Name of Facility |
State and Jones Coffee
|
| Facility Contact Name |
Shelby Harris
|
| Facility Contact Phone Number |
+13123716969
|
Existing Permit
| Facility Name |
|
| Has anything changed since last year? (Enter N/A or no if no changes to owner, systems, etc.) |
Yes, change of ownership and name
|
Owner / Corporate Information
| Owner / Corporation Name |
State and Jones Coffee
|
| Owner Contact Name |
Shelby Harris
|
| Owner Contact Telephone |
---
|
| Owner Contact Fax |
---
|
| Owner Address |
---
|
Certification
Certification
| Full Name |
Shelby Harris
|
| Registered Agent (if applicable) |
Shelby Harris
|
| Certification |
Yes
|
Verification & Permit Fee Calculation
Fee Calculation
| How many subsurface system (exterior) tanks does the facility have? |
0
|
| How many Manual (interior) 10-100 pound units does the facility have? |
1-2 ($75)
|
| How many Automatic Grease Recovery 20-35 GPM units does the facility have? |
0
|
| Is the payment for the current year permit considered late? (RENEWALS ONLY: If today's date is prior to May 31, 2023, the answer should be no. If today's date is after May 31, 2023 the answer should be yes) |
No
|
| Please enter how many years permit has been unpaid in the past (please enter 0 for none) (RENEWALS ONLY): |
0
|
| Notes |
|
