Laserfiche WebLink
,�LT ( By� `. d-1 J-a7 7 . �t•ll•fa iu _�.y <br /> Post-its Fax Note 7671 1oe10 j I� f T7 <br /> T <br /> 99-122 <br /> I <br /> SAN •� AQULV <br /> PUBLIC TS SERVICES 64W.Ljo 4ar <br /> .M4VlR0 AL REALTH DI 7,91019 <br /> PdHLIC MCDRI:)3 R,g_T. ASE APPLICATION <br /> APPLICANT (LYIIlYjP,l(1. PIIC)NS Nr? -7 -4A2(o l cf_-)c7 A <br /> AbDRZS3 7 <br /> AIGENCY iQAMs PHONE NO <br /> ADDRESS <br /> . itt�f4�ir�tfttt#�IrY�lrtfi•t*#•,4*.•k*h�tyttt• xirfs•+t4rt#jFtt•tt#�r•ht•k3�!•#tt�l•-tr,kt#irjFt#**�►•t <br /> NAME/ PROGRAM Oil <br /> t TxPE OP g7r.rr <br /> i 1Ji�e <br /> e <br /> -' -S `•(J <br /> -- ✓ _ ;ter <br /> YJ so <br /> � -- -----: _ y _, - - <br /> IA <br /> abac -ay, Ya +. <br /> t#ft,r�ir��r,ei�►*trttrx�t,i•t.r•rf•t•ft,r,••,r,t•� ,r,t*,r#,r*•,r•,t,e#:,rrrttr•*yi,r*#*�r*ttr,t,r,ttttr•�x <br /> E <br />— . ---_n31s NOTICE is.SUBJECT-Ta THE REQUIREI IENTS IDENTIMED.IN TH.E PUDIC HEALTH �- <br /> SERVICESIENVIRONMENTAL HEALTH DiVtSi N IEHO) POLICY #94-007, ORDINANCE CODE OF s <br /> SAN JOAQUIN*COUNTY, EHD FEE ANO SER 4 CE CHARGE RESOLUTIONS, SATE WATER COOS, � <br /> GOVERNMENT CODE AND THE EVK*ME C DE. <br /> i. A MA7QMVM.OF Tat PREMl$rt*AOQl MSSFS PER REQUEST <br /> 2. POW.C FILES/RECORDS REVIEW IS'ay Aj POWiTTADIT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED 6Y CALLING 1209)40,34201. OFFICE HO(RS FOR APPOINTMENTS ARE SCHEDULED MONDAY j <br /> THRU FRIDAY IMCLUD(NG HOLIDAYS, 8.00 kM TO 12-.00 NOON AND 1:00 TO'4 3Q PM. <br /> 3, A PVBUC HLESIRECORDS RELEASE'A CATION (PRRA) IS REQWRED. <br /> 4. PUBLIC FII..ES`RiECORQS NOT RETURNED THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE END STAIFF AT THE EMSE OF THE APPLICANT, THIS ADDITIONAL <br /> SERVICE 1NttR1 Be i31I.iED TO THE AOPLICAN FOR PAYMEPiT. ISEE I;tiD POLICY 94-007) <br /> 5. ORIGINAL PUSL.0 FILMIRECORDS SHALL NOT 8£REMOVED FROM THE EHO PREMISES. <br /> . .fiii♦ia�.�����♦♦�;i+.t.��r .. ii•1• .�..�{r*.I t���+►a�+•a.pio•�r�a..�• }'���r.�1i <br /> SIGNATURE OF APPUCANT OATS <br /> SIGNATURE OF i1Ei.EASM}G OFFICIAL DATE <br /> EH 00 74 MEV.W96) . .' <br /> MAY 1' 3' lr4gci <br /> TOTAL Fl.02 <br /> 1- <br />