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�^ 0 <br /> 11/i X85 lE 07 _ 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> DD J OAQUIN COUNTY --- - - --_ <br /> ENVLRONWnAL$EALM DEPARTMENT <br /> 7 20t-�-� 304 East 09)468 Avenue,3dFloor,4 Stockon,W b,Www <br /> -sj& v 37V <br /> Tdephora:(2U9)A683A20 Faz:(2aJ)464-0138 Web:wwwsjgovorg%Lddo <br /> ENVIRON101ENT HEAL T�i <br /> PERMIT/SERVICES 6BUC XW61 S RMEASEi APPLICA,TXON <br /> APPLICAtfF: W$0a=AP9lCr: i L . %c; 1 �U&J* <br /> ADDRtM, D � � �.( <br /> HOMM(iresLa z)•-yy9i PHOIM(2): ��us �)�1G4-9da7 <br /> TENTATIVE'APPORfS1tENr DATE <br /> • tam.�rioaap�ar:froma,mor„�u�.as,�,aw.•ra,aerb�,y.,,,,�e��n�m«n <br /> _� ❑ CHECKBOXT0E77M(iFRE .ysaoo (a4sHORoit%MN)-MWaTPRocEsseav+srces ssoArs <br /> -�SIGrNATURE OF APPLICANT DATE <br /> 11FaTDISTit[BUTbN 0Uoa1 "0 4 •13Utat6 i tl oawtd=t,, salqu <br /> FILE ADDRESS <br /> uaoae E Mfg&Uaae aw, EIiD USE ONLY <br /> ✓✓ ✓ z /u 114 to n 2 <br /> W <br /> NFf 4 N; <br /> 7. <br /> 8. . . � <br /> 9. <br /> 10. - <br /> Speolllopato Rmnge of IMamation ttequastad:Fran to <br /> EWROHM TAL HEALTH DEPARTN MT FtLEs <br /> ezuaorarctmuroTaaNstiTzea«,psueryoPl tlAeAreueKr Ja'sauowrarepAo�umY <br /> On=oz"JpsRE WW4jCIM 0 FOW F-icamr M W-z"TM <br /> U =Tans(douro avAt) 0 Dao KPlNm P Dam' <br /> FlA7Aap�(7SWAttE GQ@1iA7aa <br /> Me= 13 WAs10VAMTncANOW PLAW <br /> tt(71'iltam�FAWiY Cl Ma:a tlpl7rfERTitlktaYauVclrErTop�ts <br /> tlTArrootsoorP o orwa/seA PLAtoUsEApptFA7pMstRA <br /> oMtm�crJ.WAT1CFAc4.ntf ,1Q•mt�atta�Asesrr�,M1�r� �rrpf'vf�.rF �n ,�n�si-tet.^ <br /> r - <br /> WMLAM&abWPMWF AMAVUAsaEFoa WON• F4ouoAv FiimArE OD AaS�OpK - pi(q 11pr�XOLDAYS. <br /> i. Jst up to.ten addroses In the Space above- gelect ftb- e(s)of fila$from the Ilst above by Gheold"the <br /> appropriate box(es). At bastone flc typo MUST bo soiected. r to f2091�tsd Oi 3a nr maH to tfie address <br /> hMiratedaboya. Address ranges will not be accepted—for additional assistance wtib file addresses,Contact <br /> the EHM Applications received offer 3:00 pm will be processed the next buslneaa d4y.' <br /> x. The E}tD will notify the appocant ff any EHD tiles exist An appointment for review W10 be confirmed <br /> approximately tan(10)days after receipt of application. The flies will be held for a ma:Gmum of the business <br /> days for review. Appointments should be scheduled accordingly. - <br /> 3. Age that Is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not retumod In the same eonditim as released will W reorganized by END Staff at the expanse of the <br /> applicant Future fife reviews by the same applicant may require a$83.00 depositprior to rcvlew. . <br /> ' itRA➢! <br /> TO 39Vd GNV-IAVO OWd LOZ68HOT5 6£:ZT 900Z/LT/TT <br />