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DATSktb'L'11IE0 <br /> ►-cr�c 14;:)j SLAW E AND I SAN JOSE _ 408 437 9526 P.02/02 <br /> OA <br /> $ AQUIN COUNTYPUBLIC HEALTFtQRVI <br /> CE3 •wu�ooMu <br /> ENVIRONMENTAL HEALTH piVIStON <br /> 304 EAST wEM AymuE,TNIRo Rook � - <br /> STN <br /> OCK1'0 CA 9Z12 <br /> PUBLIC RECORDpm <br /> R ASE APPLICATION OCT 1 7 2002 <br /> " WS;NEWANNc�r_ CNyiro.,m�n ��SE K S� <br /> ADDRESS �Ya j A.M n _. n"I <br /> Avr .Saw des r t� Si.S%3/ <br /> PIiONi: yo - S'O-5677 FAdWU OR 3 7- 9's,2,/ <br /> TENTATIVE"APmwmaw DATEjo _-2 Y1/oz „jute 9:Q i9am-. <br /> IPI"""r to 1 arsvaHG7mm submlwq <br /> C1 CHECK BOX TO 19MI'm REQUIDIT-sun M- ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE « <br /> -- �A�w/AY/r�O11�1■ wwwww�w� <br /> RLE ADDRESS TKI3 3WO M STAFF 5 Y <br /> FROCRAM EL MENT11 SEARCH <br /> A <br /> • <br /> UA Imly <br /> ------------ <br /> A <br /> UNDERGROUND TANK(USTI CV.AM up SnS(LOP) O HOUSING ABAYEMENT 0 SOLID WASTE FACILRY <br /> OTHER FLFAl W SITE PON4AM O FOOD FACILOY 0 SOLID WASTB VEHI= <br /> UNDEIIa4oISM TA K IIM Ata D Don KEIUMt. 0 DAIRY <br /> NAZAIt00tfs WASTE OWWtATOR O CHKXXN RANCH 0 VK91WATMIrrPLANT <br /> O Tom Pumar >m FACY.nY Q MOTIILmoTEL 0 PUMPER TRUCIOVARO/CMEM TOILETS <br /> d TATYO0AIODY FEIRCM 0 POMAPA 0 LAW USN APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O OTMER IPLEAS9 SPECIFY ABOVE) <br /> 1. Ust 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 ono fie type MUST be selected. Fax fZOsi)40138.or,mall to-the <br /> Add_mss la /dated awve., I , <br /> 2. EHD will notifp the applicant If any'EHD tiles exist. An appointment for review will be confirmed <br /> approxtmateiy"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 bleing 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_T of returned In the same condition as released wig be reorganized by EHD staff at the expense <br /> of the appgcanL Future file reviews by the same applicant$nay require a$88-00 deposit prior to review. <br /> S. •TENTATIVE appointment dates must be confined with EHD Staff. <br /> 6. Applications received after 3:00 pin will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> ftEVtEMVEO YES NO REVIEW DATE •• <br /> TOTAL P.02 <br />