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-- .. 'All! 1��LJ{N CC+UNTYP .1r' 4� <br /> 13L'1C HF <br /> ALTH Si~h't1l <br /> V[Ft0NrV7ENTA1. HEALTH DivIS10rl <br /> 7 201, <br /> i 4 FAST WFZeF-R AVENUF.THIi�'D FLOOR <br /> . = ST4Glf7'OIV �1y 95;Lt12 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT <br /> QiISINESS.tAGENCY <br /> -�-`�FACSIMILr — <br /> TEN TA T iVi_"APPOINTMLur C.A7� �>� �— `'� <br /> (Ptcazv r(tvc i l4 74 e'UStpCSS NY from ei— TIMS .—(!_e <br /> c of appltG�tFgrt suUi�utt:.l) <br /> C iECIf.a''.OX'IQ,:XP!plTE nC+�U�ST•'' <br /> biC A}pCt$$� ilIGNATUN'E OC ( <br /> K•iNL.IJ i��SY`i <br /> Tom_Tlit�SIDEf;Fid aTAFFtJs1,:;)RLY 3 <br /> F-NV1R0Al;Y1L-N,rAL til=TkI..T ff DIV)S1 <br /> u+C�c+�GJ�DUceU;AIyK(usT)et.r,yrcuts:I(Y� + orl i-tLES <br /> D 171—Ct,EANUP SS7E!NOD1•LOY} (,DPS � IiGUSttIG ADATEMENT <br /> 4�'+C�JtiDERG1�0UNL:'T.tA(t( E4UU FAC1llTY rr SdLIL YYRSTI=FACiLiiY <br /> ST4nAtrr013Ir1Gl:tiEFr1t7VAL) 0 ❑0G rEH,4a SOLID WASTE V!riiiCLG <br /> iJ,Q ARDdU.:>WAXT2;GENCiRATOP 0 DARY <br /> ❑ TIERL'D PErt,wr 7kp rACILITY ttllCi;EN AANCR • . <br /> 0 TATTOOJ800Y I�JjRrING 11UrEt1H0TEL LI PI(GTRL-AYMENTPLANT <br /> 14.17v <br /> rnGD3Cl+d.YrAt;Y'- u POOUSPA PUMPER TRUCK))-APDJCHCM TOILETS <br /> E rAf C] PUtiLi(:yp LAND USk!AYPI- <br /> ATLR SY.fTLu tCATtOtt SlTfwg <br /> ' gist up to tern aadressGs 1.1 tllc space above. Select the t r � zfrooPCCsFYACiCrYt_) <br /> the ZIPOrDpr ate box(est. Y1►e{�} of f31or, tram the list Ql)uvu u <br /> a fss indreat d . ` At!cast ono tilt type MUST be sLj0CCod. Fax tr, 2UfJ a Y chcekirq <br /> y pboyc_ a1; orrrrxil_ t� the <br /> x}313 wii -hot:f thea ___.•- <br /> Y pp(iGartt ff any Pl files axist, ,ctrl appointmcpt for reviow wit!be CUtlfirMPd <br /> appraxiiYl t�ty five businass days bi.d no later than tGn gyp• <br /> v'�1I be ,geld far,%.mar_flnum of Sig t r daYs aftcr receipt Gf ppfic,,fton..7-he <br /> files <br /> aeooTdir►oly, rc businQst days for ravie<W, + F4intiticnts sl�oltld be s I <br /> A file tn�t is etivcly lapin chadtil+:c <br /> appiicailar`m� _q warkod on by Elio stZff maynot 1a <br /> 4. Ail t. Y c zuJitattQri when u)c:filo 4 uvallabi4 IMnrcdiatrj <br /> Y de mac:c=turned i;I [hG soRta co y available for rf:ricw• A aczv <br /> of ttze aLPP"";Ant• guturo file r(.'}r;cw..endition as rcFcasr, will be:cur ar.izrH <br /> S' ` i=kiTa',con aopollltment Cates must bc+he rams applicant may <br /> raquh c a W-00 fc apor.K at the pr or in revlcv►. <br /> pGnsc <br /> 6. Appiicatir,n5 rtgcujVc Yonfirrncfl with E?iD staff. <br /> G afior•i:�Q Pm wilt be proccsoGd the neXt b ff' , s day. <br /> CONFIRMED OPOINTMENT PXi-E <br /> F.. vtCwl;,� Pfivrr� t-AX <br /> YE:? IAfII'IA1� � <br /> art w is .QtiG a t�lU -""`�-,,,,.• ! <br /> t1=vl�ry DA'rv, <br />