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01/14/2005 09:46 FAX 209 948C �I002/002 <br /> RECEIVED <br /> SSAN JOAQU�I COUNTY <br /> C�C�OML D ESO"IENTA REALT)aDEPARTNMNT Q <br /> 304 E Weber Ave 3 Floor Stockton;CA 95205 <br /> (ZP� 468-3420 Fa c: (209)464-0138 Web:tiwnv.co.san joaquin.ca.us/e}ad <br /> ENVIRONMENT HEALTH P TBLIC RECORDS MLEASE APPLICATION <br /> APPUCANT' Avg `Y`�(btj`.�J SUSINESSIAGENCY: KIe;mP&� <br /> ADDRESS: 3?-3 C� os - <br /> PHONE: FACSIMILE: oZ.1 QqT 'Ofoo��• <br /> TENTATM*APPOINTMENT DATE: , �� l oi' Time: <br /> (Ptease allow 10 business days from date of application submittal) <br /> rl CHECK BOX TO EXPEDITE REQUEST-$33.00 FEE,REQUEST PROCESSED IN 3 BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT � _.,...Lj ' DATE I0 <br /> Deoartrnent Use Only <br /> FILE ADDRESS UNIT <br /> ,- "r va a $ �.� /y3 �.. ❑ ' Unit 1 <br /> a. street r- 4 t)tva n . E Unit 2 <br /> 4. sem, <br /> AV r, <br /> I' <br /> 6 s l-o i no a <br /> r. sveei12921 „ a �� / M Unit 4 <br /> e. sum <br /> % ❑ Unit 5 <br /> ,o. saw a <br /> ty <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> ROVN <br /> O TANK(UST)CLEANUP SFM(LOP) ❑ HOUSING ABATEMENT §d-SOLID WA5 tLCrY <br /> UNDERGd FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHERR(5UNCLEANUP SITE(NON-LOP) <br /> We UNDERGROUND TANK(MOHITORINGIREMOVAL) ❑ DOG KEN RA 18 DAIRY <br /> a HAZARDOUS WASTE GENERATOR 0 MOTEEN RANCH ES-PU ERTRAENT PLANE <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL � PUMPER7RUCWYARDICttE_M TOILETS <br /> O TATTOOlBODY PIERCING [IPOOL/SPA LAND USE APPLICATION 5rPES <br /> ❑ MEDICAL WASTE FACILITY d OTH5R(PLEASE SPECT <br /> 1. List up to ten addresses in the space above, Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 4fi4-0138 or mail to the <br /> address.indicated above_ <br /> 2. EHO will notify the applicant if any t;I1D files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five.business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be 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 <br /> of the applicant.. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 6. "7ENTAT11VE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 pm will.be processed the next business day. <br /> TIMI; <br /> ENT:D'AT�; ` :,�;Y ..i?- .w'•: <br /> `� .. • . - .•�,:.�..',._'..:.,s ?' ' • — ::•• . <br /> .._. ... .:. •. FPli N �..,'iNi?1A1-S = _�•::' <br /> O E : FAX.:.,:,-ate <br /> 0ATE4:.0NFI�tI 66 ;t . t <br /> E21;V1E`NEO YES NO REVIEW DATE' ' <br /> ' EHo•fa-al-0as <br />