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Jun. 22 20� 1U: titrr ra <br /> FRl7P1 i`i��11 Ernrirar�sn t.a] PHONE NU. : 209 --,69 4�23 _ -]— -- <br /> S ICAQUIN COUNTYPUBL IC HEALTH(( RVICES .. MME��IIC��1�J ED <br /> ENVIRONMENTAL HEAL-rH iDIVI9M <br /> $94 FAST Y 8WM 0,VOUL7HIM i WCW JUN 2 2 2000 <br />'4 6MCicr0H CA tlfl <br /> PUBLIC RECORDR�E�APPUCATION ENVIRONMENT HEALTH <br /> 5 <br /> AP PUC AK; rte-k t euata G 3�- D A t,4 N atf- o" <br /> Awl s:: 'rL r-d U5 ID h1 LA-"6 "C>-i <br /> 2�DCJ—"�je CT [41 <br /> TEWATiVO AFP01ti'rMENTUATE It r.yaw <br /> �raer.ee�t m-ec buaw.re mr.tsmn�.at�seatenNts+31 <br /> Q CMCK S=TQ LDJI' E=T1".RECULUT•MAO FL*-fMMSTpR0==Wjfj 7 �C1►Yx <br /> SK"TMR OF APPLICANT " DATE0. ��f�.�•�� <br /> 4{aL . Acapc, Jho A �. <br /> ca.rn 2 <br /> �I <br /> t <br /> k <br /> �r <br /> O&WX MENTAL HFALTH EWM014 Ft= <br /> frit UMEKOROUND=UK sW"MSAwUP*9M#MM a t9RWW^g&TWWff n aolm"LMMPAMM <br /> �arus:Acr. w�slrEitlar>�o�l la M=FACsry 1) v 3WWW" eVm= <br /> It filic3eZGtft�}r�y114 t>aa Q QW xm0m. +� Q'�Y <br /> �YIJlsItEue M C�CEMPAWN P. a PK611WA Pl-�► Y <br /> n TimRt41!�rile6r�7rAtaLr�f a ftG lilG7�L q pU"rW VWCff #WICHBA Voi.M <br /> a TATTdamcm Thmsmmoe P00uWA �� CT L.NW US&AfMLG✓MMS= <br /> G .iIIFABR`F Y PLtsl.QWAT=ZY8TfA40 G 0t1t& QLEAWWWZSFY/113Q1ff t <br /> 1. Lk"up to to &&"ire the ap" above. Sakura the types(*)oiti teas!mart tw tin above by cpacking <br /> ttfo apprapruft bQx(ae). At hmat OM Me tyke W=T bar SiWedad.Alga <br /> �, I:1Bd.di 3s or rrr a�o 31er <br /> 2 EH3 wm rtow tls*mm,.L stet If any mon fiiau eadsa- An uppowwout <br /> for rayrtew will lre cazefirrrmd <br /> appraxlr awy ft*buwno"days taut no fa utr ffz m tm(4Cl days atw r,dreiptaf appuzatwie. The imers <br /> mill bo tsetd for a maximum of fixe buainteeaa days for review. Appawountx shmAd be ache ed <br /> y tsar may Out be lnaaiugmmiy avelhMs for rQWWmr. A thew <br /> 3.. A fiil4th�at�x,a�ctivel i�ireg worked qri �liD atlftt i1 <br /> app My he submitted when the file is aysilJ3i L <br /> 4. Any lila sat ragt4#nen In the"Ma cmdWon as nA*&srgd will be rparigantmd lay EM staff at tiara aeipanw <br /> of tiuf�tpllcsftt. FurkuM file reeYiawer by tfne same xpP�cs:rt may raq�a��0 depasii pnorta m+rtaw <br /> 5. "TENTATM appoieebM t tura mfsst be COnfinmed-mth EHO GUM <br /> L App}ieaom*mcsWad 01W 3.-00 Pre W1U be praceessed ttfe iniad b usinvas daY. <br /> fi <br /> �r <br /> CONFIRMED APPommENT DATE �r -nfAE <br /> DATE CONnRNOW PHONE I'� FAX WT(tAi.S ...,...�..`. <br /> Rt=VfEYMED YM NO REVtI±W OATS <br /> �.wt+os ,� ZOrtA� x.01 <br /> :F <br /> j{ <br />