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.: rF � -� r :: =•�y- '� � '�'.s, a �4„• u( - i ��-6..+,�.�# ��i�-�- 3� <br /> y <br /> COUNTY <br /> r'PBL' C1_HEAS�THSERVIGrES <br /> 4ROIVMEN'rAL�HEA�TH�1�I'VfS <br /> �” _, , 1dUBGRECDRbSRLEASB�APPLI ,�T�ON� <br /> 0 57v <br /> a <br /> 71t <br /> AFPLICAN'I' <br /> ' -ADDRESS D. , <br /> AGENCY NAME;3 .t f �> HONE <br /> rADDRESS �.: <br /> c <br /> „- _ is j <br /> *�k4' 4'f F+ 4r 4, 4t ,�* kk***+,�t*******+fir* f+x <br /> ._ E` PROGRAM OR <br /> FULL ADDRESS BUSINESS N TYpE OF FILE <br /> FACILITY F <br /> REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> NOTICE 15 SUBJECT TO THE CODE OF k <br /> THIS 0 <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) POLICY 1194;,007, ORDINANCE <br /> AN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE R,ESOLUTIONS, STATE WATER CODE, <br /> S , <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. i <br /> 1 . A MAXIMUM OF TEN L101 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> RE SCHEULED <br /> ED BY CALLING 12081468-3420. OFFICE HOURS FOR APPONOQ EAND1 00 TO 4D30 PMMONDAY. <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 <br /> 3, A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRAI IS REQUIRED. <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE. SAME CONDITION AS RECEIVED WILL <br /> NAL E <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007} <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD pREMi$�S. <br /> ►ffrts►rtaafrtrtafafrt+aaartrttaaffafrtarta+*f*+rtfaasaff+aa�+a taf aaffa••ra'rtatrtaat+++ <br /> 1� DATE — Z S— ,'7 <br /> SIGNATURE OF APPLICANT <br /> RELEASING OFFICIAL �( DATE <br /> SIGNATURE OF <br /> EH 00 14 (REV 9196) <br /> �j <br /> if <br />