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04/10/2008 15:07 FAX [ 001/001 <br /> V '�.. oro..�.,.. ,......�„ <br /> OATI RECEIVED SA,,N JOAQULN COUNTY <br /> '����V�l ® I <br /> EirYIRO vlYIEiYTAL HEAI Tli nEPAFLTN1EhT <br /> 304 E Weber:Ave 34 Floor Stockton, CA 05205 <br /> Ar? 1 C �UUb (009) 468-3420 Paz: (209) 464-0138 Web: wtirh.co.san joaquia_ca.us/eh� <br /> ENViR04l!�VIEN4 T HEALTH <br /> PEWIT/SERVICES PUBLIC RECORDS RELE_-.SAPPLICATION <br /> ,�,®_—� <br /> A,PLICAN.f. BUSIMFSS,'AGENCY: <br /> ADDREss: E I. oG . <br /> 1 —.. FACSIMILE:�� 99 <br /> PHONE: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 besine= day%from date of apPlption svbm'ttaq <br /> 13 CHECK BOX TO EXPEDITE REQUEST-S91.00 FEE-REQUEST PROCESSED IN a BUSINESS DAYS ! <br /> /L DATE Do / vrem Us 0* <br /> SIGNATURE OF APPLICANT -�r4tL_—� <br /> OcWnr'��nt use OrilY <br /> uNR <br /> FILE ADDRESS <br /> L 7 ,� p i jtt <br /> ]. SVo4 ! \ <br /> Unit 3 <br /> r r �,/ <br /> s� <br /> D a 4 unit 4 <br /> r. <br /> Unit 5 <br /> Ie. GteN ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IiQ.SOLID WASTE FACILITY <br /> III OTHER CLEANUP <br /> TANK JUST)NON -OP)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLIDWASTE VEH1ClE <br /> III OTHER CLEANUP SrfE(NON1APj 0 FOOD FACILKENNEL <br /> Tr aL DAIRY <br /> t& UNDERGROUND TANK(MON: QVAIj 0 DOG KENNEL g_pKG TREATMENT PI�FrT <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH (3 PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACI4RY 0 MOTELn10TEL La LAND USE APPLICATION SrrES <br /> ❑ TATTOOMODY PIERCING 0 A <br /> ❑ MEDICAL Y(A.`•TE FACILf1Y 0 OOTHER THER(PLEASE <br /> PLEASE SPECIFrj�,-_..... <br /> ypes) of tile.from the list above¢y checking <br /> 1. List up to ten addresses in the space above. Select the t <br /> . the appropriate box(es). At least one file type MUST be selected, Fax to 209 4Sd-0ij3I °..r..rc'ai�t°the <br /> address indicatrd above. <br /> 2 E}{p will <br /> not <br /> the applicant if any EHD files exist. M appointment for review will be confirmed <br /> approxlmatBly five business days but no later than ten (10) days after receipt of application_ The fibs <br /> will he 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 he immediately available for review, A noW <br /> application may be submitted when the file is available. <br /> 4. My 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 593.00 deposit prior to review- <br /> 5. -TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g, Applications received after 3:00 pm will he processed the next business day. - � <br /> - <br /> t:ONF,iRMCf7 AP._POINTMENT"DAZE _ <br /> TIME ,.. <br /> DATE C04FIRNtED PHONE FAX 'iNfjIALS _ <br /> REVIEWEDYES NO REVIEW DATE <br />