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RAIX—XIVED <br />SAN t NTY <br />JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL H JRAL hone: (209) 468-3420 Fax: (209) 464-0138 We: www.sjg0v.org/ehd <br />PERMIT(SERVICES b <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:.,~ <br />BUSINESS/AGENCY: y y. <br />ADDRESS: <br />4 ivy <br />PHONE (1): •, �,., I Sty CITY/STATE/ZIP: �aLLi{1L+ �t/,z�;K_ C�1 c'dL15�� <br />4 S • `f' ; <br />PHONE {2};l 5',A. U,- ! i)(i _ FACSIMILE: <br />�� Please allow 10 business days from date of application submittal for the re <br />CHECK Box TC) 1)11,r:,,,,,, view cords to be avails <br />J!' Staff will contact you to arrange an appointment date and time tLJ UHICKEN RANCH/ DOG KENNEL o rethe reClu!?srl fara,.,, ble. <br />i �i, {� <br />Z } <br />❑ HAZARDOUS wASTEIHAZARDOUS MATERIALS Q MOT7=LIHOTEL ❑WASTEWATER TREATMENT PLANE � � <br />❑ TIERED PERMITTED FACILITY Q PUMPER TRUCKIYARD/CHEMICALTOILETS <br />Ll TATTOOIBODY PIERCING El POOL/SPA Q LAND USE APPLICATION SITES <br />/ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR, REVIEW: MONDAY -FRIDAY 8..00 AM-5:00pm (EXCLUDING HOLIDAYS) <br />1. 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. Faxto 209 464-0.138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:0t? pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of END records, please contact EHD at the number noted above. <br />3. The EHD will notify the applicant if any EHD flies exist. An appointment <br />days after receipt of application. The files will b8 held for a maximum of five businr review ess say f r reviewonfirmed Appointments <br />(10j <br />should be scheduled accordingly. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />Xk <br />PtV ICU <br />i, i i — -- —•—�.� - A Ir <br />f pr71 ri- 51f-,Lri 1 �(:/, <br />l R7�i5initp�_ r'r.;. L3 �} .ILS t►1_�I ru li nr .-7 <br />50 is SiEC-crlv"PQ <br />p 4+t1- X�-6zy�iy 5c�c�Fra/�ar�{ <br />2LW--Irnson r AUVICi.1',} of m r x� Iiy? ��1iu�P a� ,�,r �z} . <br />P�1a24lFfil $C�S3�fe17�`71ryll .4r,^/�# •USr ips%zili. f I.ISJ j�LZoc? <br />1715 Lrririhe-4�yl '-'NWPl nrl (�Pi�fl� _ ( I tcv► z[j stx�--�.A14xgk IFwj Wal If 11 <br />