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J _ <br /> N <br /> r -2 7 - t ig,+r, t t = t sarl me tirr_ N(' oc:,9 956 0700 <br /> SAN JOAQUllN COUNTY <br /> PUBLIC 11EALTH SERVICES <br /> ENVIRONNuf% I'AL IIEAI,T'II DIVISION <br /> 17U111LIC RECORDS RELEASE APPLICATION <br /> PILONH NO a5I4 Or <br /> AppLICArrr_ f CA. .�E S , i« on L(R `j & <br /> ADDRMS c(i C5 W - A ( � p1IONH NO <br /> AGE'NC'Y NAMH�{5 <br /> ADDRESS .- <br /> L) Al <br /> 1W �2 3S. 7 Y"Arn m <br /> o y I n <br /> e3S. J 7 nt <br /> 1 <br /> � h� a, � a4 _E <br /> m AZI m1dQ . <br /> m k F . h4 f_ --- — c D 3 S. d 7 ✓� M <br /> -- <br /> ��{ <br /> i A <br /> o rr �0I+ , n` . <br /> 345 ree 4 7"t 3 5 ' 2 7—t22 <br /> via <br /> '17115 NOTIC[t - 1S SUtfJECT 1'O ` lllE REQUIR6p1EN'TS IDEN'll74)01 . ORDINANCE CODE all SAN <br /> SERV]CFS/ENVIRONMENTAI. IiEA[:nI DIVISION (Pill)) POLICY p92� <br /> JOAQUIN COUN`PY, Ill) FEES AND SERVICE CIIARGE RESOLUTIONS' STATE. WATFIL CODE., - <br /> [IOVRRNMENT CODE AND 1114 HVIVENCH ODE. <br /> 1 . A MAXIMUM OF TEN (10) PREMISS ADDRESSES PER ILEQUFST- <br /> 1 - P()AI.IC FII .ESIRFCORDS REVIEW ARE BY Q}`po�I�Yl*.LGL` �-:tI APS ARF SCIIE �i ARE <br /> ARR ANOED BY CAWNO V209)468 03"B' OFFICE HOURS FOR APPOIN"1'1.1 F.N'!s ARF SCItEp'JLED <br /> OLIDAYS, 8:00 A.M. TO 12.00 NOON AND 1 :011 P. M. TO 4:70 <br /> MONDAY TIIRU l' R1DAY EXCLUDING H <br /> P. M . <br /> 1 , A PUBllC RECORDS RELEASE APPLJCf.-DON AND A N� ISLI� _L .E DEPOSIT OI* S ARE <br /> IS REQUIRED• DEPOSIT'S WILL BE RCTURNED To 111E APPLICANT IF TILE FILES <br /> fRECOR! )S ARE <br /> NOT AVAILABLE WITHIN IIIB CUSTODY OF THE BIID. • <br /> FEE <br /> q . 'Il1E ABOVE IDa"1F114:D DtiPOSI.1' IS APPLIED T'OWAROS TILE .rOTI0IREVIhWlN 1 � iii <br /> CIIAROE. TILE AALANCa OF 141E CIIARC ES ARE DUE AND PAYA1tLE PRIOR_ T <br /> DOCUMENT(S). <br /> g - PUBLIC FILESIRECORDS N(YT It" IRNM3 ItJ 1l IE SAME CONDITION AS RECEIVED WILL ULE <br /> CORIlH(717!D BY 717" 13 Ftil) STAFF AT T1IE EXPENSE OF 111R APPLICANT 11115 ADDITIONAL <br /> SERVILE WILL HE BILLED TO 1118 APPLICANT FOR PAYMENT. <br /> ti. ORIGINAL PUBLIC 14 F-SIRHCORDS SILALL NDT BE REMOVED RtOM 111E E"D PREMISES. <br /> 7` DATE I <br /> SIGNATURE OF APPLICANT /�Lt /L-tom <br /> S10NATURE OF RELEASING OFFICIAL — <br /> EII 00 14 (BEY 12192) <br />