Laserfiche WebLink
SAN j4AQUIN COUNTY <br /> pilC HEALTH SERVICFS <br /> �IRU�iTAL gEAI,TH DIVISION S r, <br /> F"LIC RECORDS AITLICATION <br /> AMPLICAN'I' 11J <br /> I , -�'�€ PHONE NO 1 <br /> ADDRESS a PHONE <br /> AGENCY NAME <br /> ADDRESS <br /> glj 13 ADDWass <br /> ------------ <br /> i <br /> ONS <br /> nr RMIT-7' �c: <br /> UC <br /> THIS [qp CICB IS SUBJECT � THELTft REQ NUIRE EHD i'dL10ENTS X� 07,ORDINANFIED IN THE CE CODE OF SAN <br /> SERVICF%fEN VIRONMENTAI <br /> JOAQUIN COUNy, EHD FEES AND SERVICE CRARIGII RESOL,uT1oNs, STATE WATER COD <br /> 1i <br /> GOVERNMENT CODE ANJ)TM EVIDENCE CODE- <br /> 1. A MAX-IMUM OF TFN (10)PREMISE"DRESSES PER REQUEST. <br /> 2. PUBLIC FILESJAI:CORDS REVIEW ARE BY APPOINT'-QNLY• i7s ARE SCHEDMENTSULED ARE <br /> ARRANGED BY CALLn4G (204)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY DMU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M.TO 4:30 <br /> P.M. <br /> 3, A M13LiC RECORDS RELEASE APPLICATION AND A MON- <br /> RFF[1NDABL.EDEPOSIT OF x"18.00 <br /> IS REQUIRED- DEPOSITS WILL 13E REMRNBD TO THE APPLICANT IF THB FILES/RECORDS ARE <br /> NOT AVAILABLE WMUN THE CUSTODY OF THE FHI). <br /> CHARGE- T#Ds BALANCE THE ABOVE INCE OFTHE CHARGES ARE DUE AND PAYABLE PRIOR TO DENTIFIED DEPOSIT IS APPLIED TOWARDS 'ME TOTAL RNG EVIEWI <br /> CME <br /> DOCUMENT(S). <br /> 5 PUBLIC PILESfRECORDS NOT RE'T'URNED IN DIE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECPED BY THE MID STAFF AT THII EXPFsNSB OF THE APPLICANT. THIS ADDI ZONAL <br /> SERVICE <br /> BE BILLED To TM APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIKECORDS SHALL NOT BI3 REMOVED FROM THE fiHI)PREMI§ES. <br /> SIGNATURE OF APPLICANT <br /> DA <br /> SIGNATURE OF RELEASING OFFICLAL <br /> DATE <br /> gX 00 14 (REV 12/92) <br /> L f�1-7 \ <br />