Laserfiche WebLink
JHIY-L4-Cl1J 1b:1'1H FKUI"I:latUl'NHSt�[IV Hl�y�by[d295 T •46901.58 P.2 <br /> Ip�pjFEIjE�F�11EVE® EHD LOG NUMBER <br /> t@••(l{Fac1V_1L�o• $AN ,IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT O' C <br /> JAN 14 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www,sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES ' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: gy—r/ BUSINESS/AGENCY: <br /> ADDRESS: 937 CITY/STATE/ZIP: /T,0041S7c ?! '-35:c <br /> PHONE(1): !a9 Q293 PHONE(2): FACSIMILE: 3-4;r9y�79� <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CA OR C CK ONLY -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNAT RE OF APPLICANT /M DATE <br /> Electronic Information: ❑ List❑Map—Descrip on: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ ❑unit 1 <br /> 1• 17Y 7 4arTcv G/7Gy ST 1Fil� <br /> 2. <br /> 3. <br /> 4. ;� G ��_' (`'�{,I!-�ll i�_� ! �T Cf�lc f1 ... _ t��UnIt 3_ �XJ <br /> Z(Unit 4 <br /> 7. <br /> 8. .. . . ❑Unit 5 <br /> 9. <br /> ❑unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK[UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLIDWASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 1i INDERGROUND TANK(MONITORINOIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> (ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> iAZARDOUS WAsTEIHAZAR000S MATERIALS ❑MOTELIHOTEL E]PUMPER TRUCKIYARDiCHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ,a' omPLAiNTIREspoHsE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 9:00 Ann-S: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)494.0139 or mall 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 conFlrmed approximately ten It 01 <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. Anew application maybe <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$125 deposit prior to review. "4�FU g.4':r.t tip U. 1.44V <br /> ❑ Records provider by Staff-PPR 6.9141ete StatI Narr1..9 <br /> eHD 14"0e BlJ92 <br /> Received Time Jan. 14. 2015 11 :49AM No. 7909 <br />