Laserfiche WebLink
RECEIVED #0304 P.0° !00 <br /> DgTE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 5 2(111 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Enst Main St. <br /> ENVIRONMENTAL HEALTifelephone: (209)468 34 0 Fax: (209)46StOckton40 38 Web:CA 30ww SjgOV.Org/ehd <br /> JAJ5 <br /> PERMIT/SERVICESEASE APPLICATIONPUBLIC RECORDS REL <br /> ;L <br /> APPLICANT:_ / /f%9 Oe/Gr,7 BUSINESS/AGENCY: Ul- <br /> ADDRESS: &1416 //P AVIT`/ 2 CITY/STATE2IP: r74"relt-r6� <br /> PHONE(1): 7f. ? q - 3 9LPH 'yg <br /> ONE(2); F11-( (-4'e(,( FACSIMILE: " <br /> TENTAT/VF`APPOINTMENT DATE: <br /> (Please allow 10 business days from date of appllcatlon submdtal-'Tentative only-must)be confMr d) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122EEF lCA CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I DATE <br /> Electronic Information: ❑ List❑Map-Descr'iption: <br /> FILE ADDRESS <br /> Strout S EHD USE ONLY <br /> Street Name city it <br /> 2. ) / <br /> 3. ❑Unit 2 <br /> 4. /5, nits <br /> 6. <br /> 7. Liniea <br /> 8. <br /> 91 []units <br /> 1a <br /> Specific Date Range of Information Requested: From i PARTME ❑Unl 6 <br /> - ,,,, / ENVIRONMENTAL HEALTH ENT FILES to <br /> MI RGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACWYYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY Q WASTE TIRE <br /> ERGROUND TANK(MONITORINGlREMOVAL ❑DOG KENNEL ❑Opmy vl//1 �, <br /> AZARDOUS WASTE GENERATORO�, L3 CHICKEN RANCH <br /> ❑TIERED PERMITTED FACILITY ❑MTEiIHOTEL ©WASTEWATER TREATMENT PLANT <br /> O <br /> ❑TATTOOIBODY PIERCING 0 O TELIH D PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> El MEDICAL OTHE <br /> MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT.RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> - should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <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$122 deposit prior to review. <br /> EHD USE ONLY <br /> ENOe&06 <br /> 07MMO <br />