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DEPT. OF TOXIC 4; <br /> EHD -CG-t,YMBER <br /> MED SANJOAQUIN COUNTY <br /> N <br /> hid 1 6 2006 NTAJ,HEALT]a M-PAR7 MENT <br /> A-vmu-, 3�"'Floor, Stockton;. �.-A 952L12-2708 <br /> ENVIRONIM!-�;I HEALTH T�.-e! -I-,-t,2-99)469-342; 'Fax:(209)464-013VW�0�,, <br /> PERMIT/SERVICES RELEASE APPLICATION <br /> ,T�PPLECANT: ZJ�e' —w of <br /> BUSIN VA01E <br /> "ee <br /> 36 <br /> 141 6 <br /> CKk K�-)X 7C 11'.xPEV)?TF REqUEBT-M.V,FEE fCASH QhR CHECK ONL-yj-pr(y,,�FS'r pfto"�-Sr -2 S rgL-IR <br /> IF <br /> .-.r-r....'- __ <br /> e <br /> kuu <br /> Desciip on: <br /> r FILF ADDRE USE ONLY <br /> J"it 1 <br /> c. <br /> L <br /> -4, <br /> t <br /> t S' <br /> Q 12 0 <br /> to <br /> UNNV%R0Nk'!t&EN'TAL HEALTH DEPARTIM,FWNT Fi'-,as <br /> TANr, CLEANUP ViTE(LOF7,K)VSING ADATMENT M smig wls'rg FACu7y/VE.N47LE <br /> CLF-ANUP SITE(MGN-'LSP? Z FOOD FACILrry 17 WA5rE TME <br /> VkDERGROLINr,TANK M Doo KENNEL' M Dx'q'• <br /> �-7, 4rXAPD0;JV'fVA-5Tr 000ERAT,R MCMI K`=NRANCH C1 WAOTM'4 TER TTWATWEM-f FdANII <br /> CI WW7E"Hoi-EL 'F.fil TO' <br /> C PGOUSPA VS?�A,?q.Q';.-k7;0N SM"$ <br /> fe"I addrs'vqez In"ho Fp Me�bo%ts. 55-,Iect the type(s)of filfts frr"'M t!ne list above by ciwoilnq tiw'app?aptL <br /> iea <br /> L%Qx(Ds),. ifit Pest cwie fiia type MUST ba t-einfed. to the zd&eza Indicated above., AdO!sas <br /> rangays-1W nof t)e °r`ToteFj-'e-er r'd-011�N'rial aseM' tr <br /> 't mnVe Mth file App,�cafiurm r,-�,s�va 1 <br /> an--f FeM oxist- An appointment fop rryrolvv N,414 be re <br /> IP7, <br /> -'he ir 4.ti is ilf�,ld for a maximum cidaye.� <br /> schpdw'oe;;macrdJ119fy- <br /> A fit..that;z acvwq' y ivcrhed,en�y EHLD S!Tffl may not be lmmvd%to€y�wzilable for mvfew. A nee/app!ici;tiosl F tf <br /> iae <br /> 4. A-.1,L 'Ve wi*relurztr-e f Vl-p YondMon;w-Li3inoved VAII be rearganize6 by Ea'.AD <br /> AD su'ff at-a-le expense ol the-i ppik mt• <br /> ffhy tha%aMe P <br /> yj�,,�y 70,qulm on$95.00 deposit r-1 t, 10�1- <br /> EHD USE ONLY <br />