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No .6288 P 2 <br /> ew 40G M�xnea <br /> Ru ?5��20L,I,1,2,:31 Ir0AN JOSIN COUNTYPUBLIC HEALTH SERV( <br /> ��1� ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 2 S 2004 STOcKTONCA05202 <br /> ENViROMMENT HEALTH f2�)aaE APPLICATION <br /> _PERN11T SERVIL PUBLIC RECORDS RELEASE <br /> „ <br /> ����"✓c�W _BUStNESSIAGENCY e v, n - <br /> APPLtCAN't_----r— t • � � L�� <br /> ADDRESS 9 0 2- 3 r d'us4ria\ W a LO < �Z g <br /> � ) -3 Gl ---IL FACSIMILE 2� - 3 M / <br /> u <br /> PNONE_�---- <br /> TIME <br /> TENTATIVE'App01NT1I=ti'1 DATE Iic Wo wbm+�l) <br /> T1 <br /> (ploas�aivo 7 to 10 buatnoss tlaya from data of app 1 y�LJ <br /> T1 CHECKBOXTO EXPEDITE REQUEST,x80.00 Q�lEST2 SSGD IN 36USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE0 <br /> FaFADDRESS <br /> PROGRAM ELEMEH-rS SEARCH <br /> C) 33(7 <br /> Q k <br /> u h <br /> 2- 11 i, to Lo <br /> ,J <br /> t Wc� r_p <br /> W . <br /> �! t ' <br /> ENVIRONMENTAL HEALTH DNISION FILES <br /> SOLID WASTE KACILrrY <br /> DERGROUND TANK(UST(CLEANW SITE(LOP) HOUSING A9ATEMENT O SOLID WASTE VEHICLE <br /> ❑ FOODFACILrrY ❑ DAIRY <br /> HER CLEANUP SITE(NON-LOP) O DoG HENNEL ❑ PKO TREATMENT PLANT ' <br /> DEROROUNO TANK(MONITORINO(REkOVAL) ❑ CHICKEN RIWCH PUMPER TRUCIWARDlCHEM TOIIFT3 <br /> HAZARDOUSWASTE GENERATOR ❑ MOTELIHOTEL <br /> ❑ TIERKD PERMITTED FACILITY ❑ POOMPA ❑ LAND USE EASS APPLICATION ABO <br /> ❑ TATTOO/BODY pEIRCING ❑ PUPIUCWATSRSYSTEM ❑ OTHER(PLEASE SPEClFVABOVE) <br /> O M%DICAL WASTE FACILITY <br /> Stied the type(s) Of files from the list above by checking <br /> List up to ten add asses in the space about. <br /> the approprlata box(as). At lead Ona file typo FAUST ba solactad. Fax to 209 d04.0138 or man to the <br /> dr_g� i�dicatvd above, <br /> od <br /> 2. <br /> EHD will notify the applicant ff�EHD tiles exist An appointment for review will bi'cco on�The files <br /> approxtmateiy ftve huslness da but no later than ten (10}days oinbnen Should be scheduled <br /> will be held for a maximum of fne business days for review. APP <br /> accordingly. <br /> r review. A new <br /> g• A fi{e that is actively being worked on by EHD siafi may not be immediately available fo <br /> applicaticn may be Submitted when tho filo ie aveilabls, <br /> re uire a¢88.00 tlepo6it Prior to review. <br /> fife not returned in the same condition as released will be roorganlzed by EHD staff at the expense <br /> q, Any awe by the earns applicant may <br /> of the applioant. Future fife rov q <br /> 5• TENTATIVE apPointMent Datos must W conrirmed with EHD staff. <br /> g• applications received after 3:00 pm will be processed the next businass day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES_ NO REVIEW DATE <br />