Laserfiche WebLink
11-14-2HNy N3:16F'i'I <br /> SAN JUIN COUNTYPUBLIC HEALTH Swie c,w wruMurx <br /> ENVIRONMENTAL HEALTH DIVISION ��� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKfON CA 95202 <br /> (209)4611'3420 <br /> Pt SIC RECORDS <br /> Dt S$RIgEatL]10EYASCWoEAPPLICATION PPLICATION <br /> APPLICANT C <br /> A J <br /> ADDRESS3 J.l-o <br /> �c <br /> PHONE ✓ - F4CSIMILE 16 7o(- p � <br /> O 6� <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 busln¢ ,Jaya frau date of appltoatlon submittal) -' -- <br /> Vr 64V17, 3, 'T/ L U 2 2__�QL <br /> CHECK BO%TO EXPEDITE REQUEST'-Ut.00 FEE-REQU T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OP APPLICANT DATE So B <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY O <br /> PROGRAM ELEMENTS SEARCH _ <br /> 0 n , 4 C 3 3 22 0. 1 7-7- <br /> o t. b e 2 / 3 90 Po z3 z e e <br /> 32 O c -- ` _ ( 39 2 a zz V 80 0 80 <br /> _ _ <br /> o L _ v b/7 / a G Z NG3 <br /> ° os - S ? 9 vl <br /> o qImply, S _ S 94 so <br /> M t 4P roc .23 / D <br /> .i <br /> ENVIRONMENTAL HEALTH DIVISION FILES JUN 26 2001 <br /> C...''' <br /> NDEROROUAD TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLD)WASTE FAC U Y <br /> 4�22OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> CM HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT f LANT <br /> ❑ TIERED PERMITTED FACILITY CO MOTELIHOTEL ❑ PUMPER TRUCKIYARD/GHEM TOILETS <br /> ❑ TATTOO160DY PEIRCING ❑ P000SPA ' ' ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIc WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addrOsses in the space above. Select the type(s)Of files from the list above by checking <br /> the appropriate boi(es). At least one file type MUST be selected. F o 09 4 e <br /> address indica(kd above. <br /> 2. EMD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments Should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will he reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant mi(y require a E8T.00 deposit prior to review. <br /> 6. 'TENTATIVE appointment datez must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> EONFIRMED APPOINTMENT DATE TIME <br /> BATE CONFIR.4 PHONIE FAX INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> N ra 17 a raa <br /> TOTAL P.01 <br />