Laserfiche WebLink
PAUL 02 <br /> SERVICE REQUEST <br /> Type of Business or Property fACll(fY ID# SiMME nRREQUESTS <br /> OWNFRI OPERATOR Baku PAWY <br /> eZ9r 1Aoyr7 <br /> swiss <br /> Mailipg Address (If Different from Site Addrew) <br /> STA reZIP <br /> PHONE 91 err. APN# Lam USE APPLICATION <br /> Pmowg#2 ar BOSDsiRK7 LouioNCodE .;.' <br /> CONTRACTOR I SERVICE REQUESTOR <br /> REQqVMR Balyfo PARTY❑ <br /> gZCCQE PINTNE#>/W 5/-571/ <br /> crnP]CID STAit; C� >e 937// <br /> BILLING ACKNOWLEDS,EMENT: I. the undmgncd property or Mines,owner.operator or authorized agent of same, adme ledge that ad Ste andfor palect spedtc <br /> PUMX HEALTH SERVICES ErMROwFNTAL HEALTH ONSWN hourly dtarges a fed wilt,the preyed or adlvity wW be baed to me or my business as Identified on this lIATTL <br /> I also®spry that I have prepared this appacatim e0Q tut the work to be performed will be donein a®roance with at Sw.WawN COuHry Odinanm Codas.Slandads,STATE and <br /> FEDEm We. <br /> APPLICANT%MTURX 2 /Z�eA/ DATE: 1� <br /> PROPEATYI Busmess OWNER ❑ OPERATOR I MAHAOER ❑ OTHMAun+ORJG.DA \jr��'(/ •`J`uJ �1 <br /> CAiNsw/,oafs PLLf!U .ny_PWrolr,dobtlon ro vT+b m�+vetl rifle <br /> AUTHORIZATION TOR LEASE INFORMATION:when app6aw,1,the owner or operator d the property foaled at the atwve ate address.hereby audharizz dre r ISM of <br /> any.ed all I Its.geotechnical dao ar0or emiroa tats its assassn"t ofo madon Iib the SAN JO,wN COUNTY PUEOC HEALTH SERVICES EwwOm iTAL HPALTH DIVISION as soon <br /> as t t evadable and at rhe same tme t is prwEed to me ar my represenmtiva <br /> TYPE Of SERVICE REQUESTED: ,/� // pV �� r /./Q � <br /> COMMENTS: <br /> PAYMENT <br /> RECEIVED <br /> JAN 15 2003 JAN 15 2003 <br /> SAN JONc;UIN COUNTY ENVIRONMENT HEALTi <br /> PUBLIC HE�LIH SERVICES PERMIT/SERVICES <br /> ENIIHONMENTA 1E.V TH DIVISION <br /> t{$PECrDRY SfG1UNRpoNTRAcraft Siamar o: <br /> APPRumay-. �; FYPLCF..`.T. Gj )� <br /> AssiGNEDTo: ErPWrEEd•`. DATE: <br /> Date Service complefto already icor eW* SERVlcaCow- Z PIE: zo <br /> Rat Mount Amount POW = - Payment Date <br /> Payment Type Invoice# - Cheek# <-. Received By <br /> ✓ r <br />