Laserfiche WebLink
�nMl:Gtlrw EnU ul)V HUMUEIi <br /> SANSAQUIN COUNTYPUBLIC HEALTH SERICES <br /> L - P ENVIRONMENTAL, HEALTH DIVISION <br /> /IXCIIji� WE6ER AVENUE,THIRD FLOOR��ocKroN CA titsaoz I/„ A� � 1 <br /> PUBLIC RECORQS' <br /> IMS-3420 <br /> APPLICATION <br /> APPLICANT_Ms A4 5NF� t7yG�Df�SUSINESSIAGENCY Spiif-di-Cl LkzE4 l u IC'tS <br /> NINf�I -(a k30U1 <br /> PHUATE �t3�(�-5_J3,3�x .FACs,Ma.$ '�t��`�► T+" 4y' <br /> TENTATIVE`AYVUINTMENT DATE_ TIME <br /> (Pleas*QIW 7 m 10 bapinozj days hemdareorappacptio rwbmittgi) <br /> CHECK BOX TO EXPEDITE REQ1Xn-$78.00 FEE.-KMUEST PR0CE5SCD IN}BUSINESS OATS <br /> SIGNATURE OF APPLICANT DarE �--a-A -�o <br /> FILE ADDRESS TW Slog M5 STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �. fjrzi <br /> 1F�U��F3A�s - cii �e <br /> T a T ii`��c_t3� F�Rz S > zl a Y >> <br /> I 5 1 C. -r2 Gvfl _ oZ Go <br /> l RS a~ �- GF�kK7L=R.- <br /> l E �- <br /> 1�J8 l~ ,-•_ C' IC' LU L"'TI�i t'1C ` 1� �` _ /? ', t,.�-, ( i:l <br /> 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> I�UNDERGROUND TANK(UST)CLEANUP Sat(LOP) ❑ HOUSING APATERIENT CT SOLID WASTE FACILITY <br /> 'FS OTHER CLEANUP 3I14(NON-LOP) O FOOD FACR(TY O SOLID WASTE NENK:LE <br /> UNDERGROUND TANK(MONITORINGUMMOVAL) G DOG KENNEL M DAIRY <br /> HA7AR000S WASTE OENERATOR 17 CHICKEN RANCH C] PKG TREATMENT PLANT <br /> 4 1"COPERMrrTE10FACILITY 0 MOTEUHOTEI. d hWPERTRUGKlYAPDdC1iEM TOUTSO TATTtMIBODY PEtRClh4 C7 POGUSPA Cl LAND USE APPLICATION SITES <br /> ❑ IAMCAL.WASTE FACILITY ❑ PUBUC WATER SYSTEM E7 OTHER(PLEASE 4FLQFY ABOVI, <br /> 1. List up to ten addresses in the space above. Selact the type(5)of Tiles from the fist above by checking <br /> tha appropriate; box(es). At leant ono fate type MUST be selected. Fox tq 4S4 p13B a it <br /> 2. EHD Will notify the applicant N any EHD fllea exist An apPeintM*nt for review will be confirmed <br /> approximately five business days but no later than ten(10)dAya After receipt of appl-kation The files <br /> will be held for a maximum of five business days for review• Appointments should be scheduled <br /> accorcGngly. <br /> 3. A file that Is actively being worked on by EMO staff may not be immediately available for reviaw. A new <br /> application may be submittal when the flit Is available. <br /> 4. Any file not returned in the same Condition at released Will ere reorganized by EHD staff at the expense <br /> of Rha applicant- Future tge reviews by the Barna applicant IRay require a s7A-DO deposit prior tD roviow. <br /> 5. TENTATIVE appolnhnant dates must bC cordirrned With EHD staff <br /> 6. Applications received after 3:00 pm will be processed the next buainass day. <br /> CONFIRMED APPOINTMENT DATE �i TIME <br /> DATE CONFIRMED PHONE FAX INITLAO <br /> LREV(EIvED YES NO REVIEW DATE <br /> FN w ft app <br /> 70TPL P.02 <br />