Laserfiche WebLink
D L�M7�V � S EHO LOG NUMBER <br />ni AN .IOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />00, 3 Q 2008 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-342 Fax: (209) 454-0138 Web; www.sjgov.org/e <br />ENVIRONMENT HEALTH 7 02 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: c? BUSINESS/AGENCY: % <br />ADDRESS; —� / �� %� CitylStatelZip <br />PHONE (1): — ��._•"---T-- <br />PHONE (2); 11 FACSIMILE:61ZZ <br />TENTATIVE* APPOINTMENT DATE: Time: GiGf <br />(Please allow 10 buslnesls days from date of aPP[icfition submittal -'Tentative only - must be confirmed) <br />13 CHECK BOX TO EXPEDITE REQUEST - E (CASH CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE UD <br />Electronic Information: ❑ List ❑ Map- Description: <br />PILE ADDRESS EHD USE ONLY <br />Street Street Name City <br />1. .2 I L7 Z ❑ Unit 1 <br />2. 6��a � <br />a Yr It It Na / <br />unit 2 <br />3. <br />4^ rt fl tt tt Il (t .v f - - - d10 � Unl \ <br />fl 5• tl tl 1l ll' �'iil ' �l' I, , i� l( `w <br />'VO(O/i� Unit <br />SL <br />a tl lA 05 <br />❑ Unit 5 <br />8' c� Ir tl r1 tt 11 (L /� u.1 <br />9. <br />10. -),ZZZ? y-. �❑ Unit6 <br />gay <br />peclflc Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES /„ �j I�ij Or <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACIUTYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE p y� ` 3 • <br />yWUNDERGROUND TANK (MONITORING/REMOVAL)V- Cl D00 KENNEL ' " 13 DAIRY <br />!� HAZARDOUS WASTE GENERATORd" M;CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT �11I <br />© TIERED PERMITTEn FACILITY D MOTEIJHOTEL ❑ PUMPER TRucKIYARD/CHEM TmLcTS / I yG �j LLri1 U, <br />E3 TATTOO/BODY PIERCING Q POOLISPA ❑ LAND USE APPLICATION SITES !l I� 4 <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY)_Q {�C/ <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8;00 AM-S:00PM - EXCLUDING HOLIDAYS. <br />1. <br />List Up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fag to (209) 464-0138 or mail to the address Indicated above Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHb filer exist. An appointment for review wilt be confirmed approximately ten (10) <br />days after receipt of application, The files will b'e held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file is available. <br />4. Any file not returned In the same condition as released will be reorganized by EHID staff at the expense of the applicant, <br />Future file reviews by the same applicant may require a $105 deposit prior to review. <br />11 <br />EHD USE ONLY <br />