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10-16-1995 3:59PM FROM AGE NC 209 956 0700 P. 1 <br /> SAN JOAQUM COUNTY <br /> MnBuC ►LTs sffitvYcn <br /> Q4,jtt 3 •� <br /> WMIOWN"AL H$AL'TH DIVISION <br /> MIBLIC RECORDS RUJUSE APPUCATION <br /> APPLICANT A'P �•I�,.,., ONE NO 9S6 OZ b <br /> ADDRM t8o2% LA Su�l�e.11} 1F1er►__C 2 2�'T <br /> AGENCY NAME �'t,,, Jnr�t��� r...,,%4 ,i PHONE NO <br /> ADDRESS <br /> DATE <br /> 8115 E. Am- Lodi f U S,<,-M J 3.5. 7 �hpi�..,ao 7 <br /> PIC:) tn0: • / -3.5' <br /> 60�© 22AT S, ch me"- ,qy—Lcpi J- <br /> ✓p 3913, S. C1.cQhxc 11,,ftgg L.adi d <br /> a ass E. Lai)i r 5 <br /> ✓o2,15 S. -A 4 <br /> ✓p Sl.fiL. C- t oW jLs-..a. �✓ <br /> ✓O -t5:.z <br /> THIS Na nCE 13 SUMECT TO THE REQUIREMENTS IDENTIRED IN THE PUBLIC HEALTH <br /> SERV1C65fENVlRONMI3%r7 AL HEALTH DIVISION(FJ1D)PU'L1CY#92-007,ORDINANCE CODE OR SAN <br /> JOAQUIN COUNTY. SHD FM AND SStVICB CHARGE RE.90LUTIONS, STATE WATER CODE, <br /> OOVBRNMEi T CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN(10)MEMOS ADDRESSW PER REQUEST. <br /> 2. PUBLIC ni ES RECORDS REVIEW ARE BY API'n1=daa ONLY. APPOINTMEN" ARE <br /> ARRANGED BY CAUUNG (209)4671.0:140. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY BXCLUDLNt3 HOLIDAYS,3:00 A.M.TO 17--W NOON AND 1:00 P.M.TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RWORDS REL LtM APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$78.00 <br /> 13 REQUIRBD_ DEPOSIT'S WILL BE RETURNED URNED TO THE APPLICANT IF THls rmc-&RIr.CORD3 AAE <br /> NOT AVAII,ABLB WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDEN'MRHD DEPOSIT IS APPLIED TOWARDS THE TOTAL f°ILE REVIEW FEE <br /> CHARGE. THS BALANCE OF 7HB CHARGES ARE DUE AND PAYABLE UOR TO REVIMNG THE <br /> DOCUMENT(S). <br /> S. P)BEIc:Flf.L9/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE END STAFF AT TUB EXPENSE OF THE APPLICANT. THIS ADIXLIONAL <br /> SERVICE WIM B13 811 .BD TO THS APPLICANT FOR PAYMEW. <br /> 6. ORIMNAL PUBLIC FILS" CORDS SHALL NOT Bb REMOVED FROM THE fitfO T'KSMISEB. <br /> SIGNATURE OF AM.ICANT DATE J S' <br /> SIGNATURN OF RELEASING OFFICIAL DATE <br /> EH OO 14(REV 12/92) <br /> ✓4�� <br />