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.eo-P ha v i rongM tafeC. FAX NO. : 2095690295 Mar. 26 2002 09:49AM P2 <br /> Luu� <br /> V N ppAQUIN COUNTYPUBLIC HEALTH SERVICES .n..nu.....n <br /> ( I T . '^IT '; �I�r�NViRONMENTAL HEALTH DIVISION <br /> 30 <br /> szoz 202 <br /> W% FLOOR �Q <br /> 02 ni 26 AP9 8: 43 <br /> PUBLIC RECORDSRELEASE <br /> q APPLICATION <br /> APPLICANT�r�r/� Iter.r/r1b�r —� <br /> �---.�"BUSINESSIAGENCY rev/d`i¢,re <br /> ADDRESS .Z 3 <br /> PHONE _6'6^f OAF 3 FACSIMILC <br /> TENTATIVE'APPOINTMCNT DATE h. <br /> (Please aROD, <br /> o b sines• TIME �_ <br /> ' rom�fapplio on subinitlal) <br /> CHECK BOX TO,FJCpEDREREQUEST- <br /> E —R VEST PROCESS. IN 3 USINESS DAYS <br /> SIGNATURE OF 4PPLICANT – 2 <br /> — DATE <br /> FILE ADDRESS <br /> THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> QN .��r " I..O M+r/fS Latif <br /> ✓i� 6 g7 �-p aro erm hd /ter w' <br /> s a N <br /> ? rfe y4 7' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDCRr ROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACIUTY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL <br /> ❑ <br /> HAZARDOUSWAS- GENERATOR t7 DAIRY <br /> Q TIERED PERMrrrr3D FACILITY ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TATTOO/BODYPUIRCING ❑ MOTQUHOTEL ❑ PUMPER TRUCK/YARO/CHEM TOILETS <br /> 13 MEDICAL WASTE FACILITY E3 POOUSP.4 ❑ LAND USE APPLICATION SITES <br /> E3 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ten addressos in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At(cast one file typo MUST be Selected, Fax to 209 q04-0138 or mail to the <br /> address indicated above. <br /> 2• EHD will notify the applicant if any EHD files 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. q new <br /> application may be submitted when the File is available. <br /> 4. Any file not returned in the same Condition as rolcascd will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the Same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHp staff. <br /> 6. Applications received after 3;00 pm will be processed the next business day. <br /> I <br /> 1 CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> REVIEWEDPHONE FAX INITIALS <br /> e��co u . mroo YES NO REVIEW BATF <br />