Laserfiche WebLink
04/87/2904 C 1 118 AGE STOCKTON PAGE 0].161 <br /> Tn9�V <br /> A _ UIN COUNTYPU13LIC HEALTH S�I <br /> / 10ES NO LOGHUM9Eq <br /> AP • �VIRONMENTAL HEALTH DJVISIO <br /> 0 7. 2003 304 FAST WEBER AVENUE,THIRD FLOOR - <br /> ENVlHUNMEN7 HEALTHSTOCKTON CA 95202 <br /> )468-3420 <br /> PERME7/SERV1S�L1C RECORDS 9RELEASE <br /> APPLICATION <br /> 3c <br /> 01 <br /> APPLICANT rr-- ,, BUSINESSIAGENCY}� ( � � � Ir <br /> ADDRESS Q a+L.J ` <br /> PHONE 6a1)4 1 UI l <br /> FACSIMILE - - dry -r <br /> W ;1 <br /> TENTATIVI`"APPOINTME=NT DATE'S 'TIME <br /> >- <br /> (Pfease Give 7 to 10 puniness da s from data t -7— <br /> D' <br /> Y application sut7rrj f,�!) ; <br /> CHECK BOX TO EXPEDITE REQU T-S",00 FEE-BEQUEST I20GE55E1]IN BUSINESS t]q'CS <br /> �. <br /> SIGNATURE OF APPLICANT <br /> DATE_ <br /> t <br /> FILE ADDRESS <br /> ii <br /> Q <br /> • <br /> !1 �� / t• !.7! <br /> .r rx_ r� <br /> F. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE I-ACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ VOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOVS WASTE GENERATOR ❑ CHICKEN RANCH © PI(G TREATIHI:NT''PLANT; <br /> C7 TIERED PERMITTED FACILITY Q MOTFLIHOTEL 0 PUMPER TRucivYARDICHIrm TOILETS <br /> ❑ <br /> TATTOO/800Y PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATIONISIT15S <br /> ❑ MEDICAL WASTE FACILITY © PUBLIC WATER SYSTEM 13 OTHER(PLEASE.BPECI Y A.BOVE) <br /> 1. List Up to ten addresses in the Space above. Select the type(s) of files frbrn the list above'lby checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209 464-0138 or mail to the <br /> address indicated above <br /> 2• EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The file* <br /> will be held for a maximum of five business days for review. Appointments'should Ize scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately availabl-dA for review. A now <br /> application may be submitted when the file IS available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff atitho expense <br /> of the applicant_ Future file reviews by the same appllCant may require a $78.00'timpt'); c to gip, <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff, 3 ��"' <br /> 6. Applications received after 3:00 pm will be rocessed the nextbusiness day. <br /> �. <br /> CONFIRMED-APPOINTMENT DATI` TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> sn ao a afroaao <br /> iIi i I <br /> iIi <br />