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Pq�IN. SAN JOAQUIN COUNTY <br /> { ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Office: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ��%FORS <br /> Request for Compliance Date Extension <br /> LOCATION: 2-/ S-6 -5. CITY: <br /> 5-Y7 d/-�� <br /> PROPERTY OWNER NAME: 1 f <br /> List tasks needed to correct all violations and provide a date the will be completed. In the comments section, pro de specific <br /> information describing the task:type of unsafe condition, type of pre-permit activity(i.e. preparation of plans, asbestos survey/utility <br /> disconnect for demolition),type of permit needed(i.e. local building permit, well or septic permit, State Housing and Community <br /> Development permit , etc. Use additional paper, if needed. <br /> COMPLIANCE TASK DATE COMMENTS <br /> Property/Unsafe Condition Cleanup <br /> Property/Unsafe Condition Securement <br /> Pre-Permit Activities <br /> Obtain all Required Permits ` y <br /> Repair/Demo Task CCS, �J v l <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task /��✓L- 12- 3 1 <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task (� k� `�jA <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Final all Required Permits 031t13 <br /> OWNER STATEMENT: I am proposing the above noted complia ce dates to pe orm each securement, <br /> cleanup, repair or demolition task to correct the violations cited in the Notice and Order to Abate. I understand <br /> that I am required to obtain any required permits for all repair or demolition work. I understand that the EHD <br /> charges an hourly rate for all time spent c4this enforcement case. I further understand that failure to comply <br /> with these com iance datep may result rther a rcement or abatement actions. <br /> 4411 _<�y /Y <br /> SIGNATU E OF PRO ERTTIOWNER/AUTHORIZED AGENT PHONE <br /> A�W <br /> TITLE V DATE <br /> (EHD USE ONLY) <br /> NOTICE AND ORDER TO ABATE DATE: PR#: <br /> APPROVED BY: DATE: <br /> EHD 13- 10/22/13 Request for Compliance Date Extension <br />