Laserfiche WebLink
01-19-09; 11 :48AM1 * 2/ 2 <br /> L-D • SAN JOAQUIN COUNTY • EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN Z 0 2959 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0135 Web:www.sjgov.� (((/// <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: _ Sar'a.� 1(owSC. BUSINESSIAGENCY: UrtS <br /> ADDRESS: a '70 0 1'Sfir- S✓t�E O Citylstatelzip _S�crara�er�-o j fW 458,33 <br /> PHONE(1): r311a- 6_1q- 'd 35 PHONE(2): FACSIMILE: Qltl- L-?-L- Q"O <br /> TENTATIVE'APPOINTMENT DATE: 0,13101 Time: 6100 av <br /> (Please allow 10 business days from date of application submittal-*Tentativeonly-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . kas-t_.9� DATE I J VO nq <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name city <br /> Unit <br /> aro4 '7 C. <br /> 2. a 55"7 ❑ UnR2 <br /> 3- b 1 1 <br /> 4. a 3 Unit 3 <br /> 5• ab34� D <br /> Unitb <br /> 6• ab W4 Lt <br /> 7• <br /> - ❑ Units <br /> 8. ab On <br /> 9• a( 'Li%l5 _ ❑ Unit6 <br /> 10. 3 <br /> Specific Date Range of Information Requested:From to Drc&"%L r <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U�tJNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13 SOLID WASTE FACILRYNEHICLE <br /> ®r/ TNER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY Cl WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 13 Doc KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH - 13 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMTOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:OOPM -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />