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�rn <br />SAN JO&QUp4 COUNTY <br />wM O N FNTA �yl DMISIGN <br />PUBLICSDS RELEASE APPLICATION. <br />�e' <br />AppucA NT GL <br />ADDRESS Ft�nN NQ-- <br />A(iEKC.Y NAME? <br />AI7DRB.SS <br />LP L_ � Q <br />�lADD_R� [ �~ <br />a23 514 <br />h <br />�0 <br />Tf1I9 NOTICI3 15 SUIi[1 GT TU 'nI9LTII REISION (`#>41)) POIJCY It92-007, ORD NANre CGDE of SAN <br />SERV[CES/ENVIRONMENTAI.HEAL71f DIVISION [EHU) J' <br />1OAQUIN COUNTY. ANI7lH8 D&NGl3VICE .IIA]WE RESOLU'T'IONS. ST�lT2r WATER CQDE. <br />OOVg�1MENT CoD <br />1. A MAXIMUM OF TEN (10) PREMISI3 ADDFtESSIiS PER REQUEST. - <br />2-1°UBIAC 11LES/RECORDS REVIEW ARP FLY APPOINTMENT C►Nt.Y. APMINThi !NTS ARE <br />E SCHEDULED <br />ARRANGED IaY CALLJNC1 (20q)46 aN �.Q OFFICE <br />. S-.00} A.M. O 12 ooINOQN �Nn 1NTNIENTS RU0 F M. TO 430 <br />MOmDAY 711RU r RIDAY EXCUJD <br />1". M. <br />1. A PURI.X RECORDS RFI.EASE APPUCATiON AND A N O1EV' N—I)AIILI's DEPOSIT ()F S7R.O() <br />IS RP-QUIRLID. UEPOSI S WILL <br />BER I- RC � 7 � THE APPLICANT IF THG [ [13i51RFSCDRllS ARE <br />NOT AVAILABLT3 WITHIN <br />4 TF11' A13()VF. IDFlVTIFITiiIi CHARGES ARE DUE AND FAIYABLE IL ] ED DEPOSIT IS APPLIED TOWARDS T14r-. A `1u REVIEWING THE <br />CHARGE. THE BALANCE OF <br />DOCI,JIVME"s). <br />5_ Pi1RL1C F?ILF�'FCORt)S NOT R 3itNED IN THE SANE Cr)NDIT1C}N AS RECWILL BE <br />FIVED <br />CORRECTED BY THE END STAFF AT 7111; E7iPCNSE OF T 4F- APPLICANT. '11-115 ADDITIONAI. <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />b. ORIGINAL PUBLIC PtL.ESIRECORDS SHALL NOT BE REMOVED M0161 TNG F111) PREMISES. <br />SIGNATURE OF APPIJCANT <br />100NA'11JR12 OF I211.1-l;ASING OFFICIAL Ltin'r-IS <br />IX oo 14 (R -EV 12192) <br />