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I i <br /> _ l <br /> 0 � �99� ��� M SANJOAQv1N catnv-rx �• �` �zZ� <br /> PUBLIC HEALTH SEAVICV; <br /> tNVmo NMTNTA.L IMALIE ll1VISION <br /> PURt.1C RECORDS RELEASE A-PP11CAMN <br /> A�uCAN r����Jn�r�i /��y i�n1 MQN-E NO 9/6� 3 7 3 <br /> ADDRESS / OD. 1 _� SG�!l <br /> AGENCY NAMERAA)L� PHONE NO <br /> (ZGNoWlJ j�27Prr/ZTI�S, C� W• i3EFG1-l�� ,gV.�i.IUE I/L4L°��r1,5y 935 <br />-t� C� + o�71ZAe4 P/Zo�'�, E, l.1 �' Ste. /a� � vF�45TST,� /��/� SrrE <br /> �A2L NA�a►2o ��`/ (o2D�l'S�Gfx 1 .���— 2D85 _ Mr*�w+rio•� <br /> L <br /> LbXj P/�2K CS E✓✓Lvnl�, Syy - SGQV.C�IA T , Ca0 ( = � yo�-j <br /> i cls �—'/V <br /> 1L 1ST- Co. 1 N 757 0), /r ►� �2r�cY .33� 19 2� <br /> �.. �� �FwGc,TY � <br /> ��J2og¢2r N1ElL�(nr(� / 6 3q 3 <br /> LLST- <br /> THIS NOTICE IS SUB7HCT TO T7IT1 RPQIllR11M►IN'Tg 11I.E.N-111'lED IN THE. PUBLIC HEALTH <br /> SERVICES/EN'MONI 113NTALIJ AT:TTt DIVIA14IN ("L))lOU('Y V74M, ORDI.vANCE CODA OF SAN <br /> JOAQUIN COUNTY, LND FT1F_9 AND STIR VILA CHARGE Ri3sou mON5, STAT 3 WATER CODE, <br /> 0OVERI`1MENT COD13 AND THE RVITIF-WLl 13-0B, PA YMENT <br /> 1. A hlAXM, s <br /> ; -ijF�I'r?N (tu) 1� MISE ADDRESS s PER F.HQUBST. RECEIVED <br /> VED <br /> JUN <br /> Z. PUBLIC T'fr PSIRI!c cTHlx9 REV1E_W ARE BY A,FPOIEfBUL-QM <br /> ARRANGED BY CAT-LINn ,br4)�H-(n4, OFFICE HOURS FOR APPO;N7�1 �Y <br /> MONDAY 1-1-MU FRIDAY PXc.:L1IL)INI} 1IQLiDAYS, 8:00 A.hi.TO 12 <br /> - <br /> :40 NOO vTH <br /> P.M. <br /> 3. A 1'IJ1tLJC'1;FI.ORDS A-ELBASE APPLICATION AND A - DLPosrr OF$78.(X),,. <br /> IS Np)ULRBLt. DEFosM w'ILL BE Rrn NED T'Q 7HE APPLICAN�IP TmE h7LPS/RpcoRD,9 ARE( <br /> NOT AVAILABLE WITHIN T-fM CUSTODY OF THB EHD. <br /> 4. 771E aOV$ IDENTIFMD DEPOSIT 19 APPLIUD TO WAR1tS THE TOTAL FILE RBvIEW FEE <br /> CHARGE., THE BALANCE OF T142 CHARD S AR fl DUE AND PAYABLE ygt¢$TO REVIEWING TIM <br /> I70G�J2•tBNT(5). <br /> 1, PUBLIC F1LP-9111FCCIRDS NUl'RR J"W IN THE SANG CONI MON AS P.BOEIVBD WILL BE <br /> coRRtCTFn T1Y TH8 La.I-1L7 STAFF AT THE EXPENSE OF V13 APPUCANT. M8 ADDtT ONAL <br /> SERVICE WILL NB BILLED TO THE APPLICANT POI; PAYhIENT. ' <br /> F. ORIGINAL PUBLIC FILM/RECOnS SHALL;•TClT 13g PEMOVFI) FR(IM'l*HI3 EMD FRI3MISB3. <br /> SIGNATURE OF APPLICANT _ DATE 5- <br /> SIGNATURE OF R-F-LEASTNO (7) Fit_7AL DATE <br /> RH 00 14 (R8V 12/92)) <br /> I jr rI �.b 't,' I , .'J 2)JJJ <br />