Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> PUBLIC ErRALM SP.RVICES <br /> ENVlRl'Q TAL HEALTH D ON <br /> PUBLIC RECORDS RM EASE APPLICATION <br /> APPLlCANT CjAg \] ' SF- „ FHONV- NO �'1 0--+6,55—4053 <br /> ADDRESS 4oqo NUJ VE, SE4;.TCIS y-A <br /> AGENCY NAME - --'^ PHON13 NO <br /> ADDIS <br /> LTf3 i]D_R__l LEAD_AGPNCY DATIR <br /> "12, s+. <br /> lllc+�c�rtrst+ti�nes�3p Alig� <br /> THIS WrICE IS SUBJECT To Tm REgU, TS IDEM MD IN THE FUBLIC F#EALTH <br /> SURVICESAINVUZONMCENTAL MDALTH DIVIStoN(WD)POLICY -OUT,ORDINANCE CODE OF SAN <br /> JOAQUTM COUNTY, FIID FF3SS AND SERVICE C"ARGA PF—SoLli-nONS. STATE WATIEP, MDB, <br /> GOVFZN?4ENT CODE V41.1"114F UVIDIICNCE CODIL <br /> 1. PUBLIC MF9/IWC0VJ)S REVIIIW AR13 BY pm f LIC. AF'.PCIINTTsmm TS ARE <br /> ARRAhNGM BY CAIIING (2099YA -11340. OFMCE ITOURS 17()R Af'MlwrmENjS ARJ3 SCFEDuL.1?T7 <br /> MONDAY 71IRU FMAY EXU.UUING HOF-WAYS.8:00 A.M_ TO 12.00 NOON AND 1:00 -M. TO 4:30 <br /> P.M. <br /> 2. A TLTIILIC RECORDS R�_ASE A TUCAT70N ANI)A NON-REFU DABL E DEPOSIT OF$78.00 <br /> IS R@QUIRI3D. DEPOSITS WIJ-L BE RMURNED TO THE AFTUCANT IF THE FaMMFcvttns ARE <br /> NOT AVAU-ABLY %TIHW TTIH CUSMDY OF JIM Fes_ <br /> 3: TII13 ABOVE IDE14'IIFIM DEPOSIT 1S APFL1ED TOWARDS THE TOTAL F LE REVD3W FLS <br /> CHARGE. THE 13ALANCE OF TR13(3LAItGTs AR]3 DUE AND PAYAltU aU T-O SVM-WWG -niE <br /> D tJC'C.f1k�IE NT{5}. <br /> 4, PUBLIC M-ESIRECORDS NOT RETURNT31'1 IN TIM SAME CONDITI[7N A5 RECEIVED WIIL BE <br /> COFMCTPI3 BY TIM IIID SWT AT IRE HJSSPENSB OF M APPLXUANT. 11US AI)DMONAL <br /> SFKVLCE WELL BE BILI TO=APPLICANT"FOR PAYMENT. <br /> �. ORIGINAL POOLIC F1LF&TECORDS SNAIL NOT FIE RPMOVED FROM THE EM PREWS?S. <br /> n <br /> SIGNATURE OF A-FrUCANT --- DATE - <br /> SIGNATURE OF RELixASWG OFFTC[AL DATE <br /> ER 00 14 (REV 10192) - <br /> ,,rte wrn� i�i7 ` 7r.;i S'7�C CRO rtfQ.fl g7:gn fit3.`97"9f) <br />