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ppF <br /> *�• =,AN _a.iA{�CiIN L A'4A' HEALTH D!'_�TRIC-1 <br /> '? 1601 E-7, Hazel t•om Avp i'.0. 8u::; 200'? <br /> 201 <br /> (20'3) 41-3 i_;-_3 422 4 <br /> Joi Evi`lLtnna, M.D. 7 Hpa i t•t? Of f i <br /> D,sCT 12 <br /> iii, OF NA TEC, DO <br /> -._ <br /> MJb AN Et_A, CA a4; <br /> �lll"iis c'I�te-eifsr ?t• iC:;' <br /> "Al"u. i C?li¢•. r a <br /> �tcit•�ft?elft• tJ T.ti janiu i''y <br /> Due Date,, <br /> 00. <br /> i_:r_rjl -9ii er Number: (",00l <br /> T�=C�;L FEE,--', iii=_ -_---�---- <br /> j 1. 0_P <br /> it <br /> NOTE: <br /> F � <br /> Nckt•ifY t.`tt' Sat :1oagLj1it i._.cicd1 <br /> Health District r.;f ElilY <br /> necessary . avLr r ermit. w:L.I l <br /> Lie rArs7aed Ldpt:!'II 1'oceipt. of <br /> #ctLilll•y. <br /> '"'tLi1='�1 F +:x'iissft• �1+�'ir +tije:•i`? trt'sfa <br /> cop- of this st1�tt.Hra:etjt. tc!: <br /> DAN .CIA-Q iiN LOCAL HEAL)H DISTRICT <br /> T <br /> ENVIRONMENTAL HEALTH PERMIT/,1:'-'ERV10E':-)' <br /> U. <br /> TOCKTOIN, CA -4 <br /> Penalties will be added a f t.er _ f� � <br /> due date as shown! 1 �lJ <br /> 1--,0r�:iy= — 100% C", BRast? r—ee, VIR©N AL <br /> R/M T/SRV, EALTy <br /> S <br />