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Pa� N <br /> 71 <br /> P SAN JOAQUIN COUNTY <br /> N ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .�q...�:1.�;:P• Office: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> �/FOR <br /> Request for Compliance Date Extension <br /> LOCATION: / 1e.e { CITY: <br /> S <br /> PROPERTY OWNER NAME: 01 <br /> el <br /> List tasks needed to correct all violations and provide a date the ta'sImIll be completed. In the comments sectiod, provide 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�r- 4 ' l' Q Z­ 12 <br /> Repair/Demo Task l✓P,� °��S � c✓ L4rjj <br /> Repair/Demo Task Lf <br /> '14 ky <br /> Repair/Demo TaskA �,�.` d �,,,,1�, <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task ��� ylf- cif r' - Ae <br /> Repair/Demo Task <br /> Repair/Demo Task C� �, �,/ "dam Glir► p <br /> Repair/Demo Task e ewl � 1 3 U <br /> Repair/Demo Task <br /> Final all Required Permits Oo 127 3/ 1-3 <br /> OWNER STATEMENT: I am proposing the above noted compy ce dates to p rform 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 on tois enforcement case. I further understand that failure to comply <br /> with these 4nplianc )dates may re in her enforcement or abatement actions. <br /> 2o <br /> SIGNATURE OF PROPERTY OWNER/AUTHORIZED AGENT PHONE <br /> TITLE J 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 />