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PHONE N]Y: 2D9 369 4220 a Feb. 09 2000 09:08AM P2 <br /> SAN ,�vAQUIN COUNTYPUSUC HEALTH SERVCES •NULvcH+,a,aE� <br /> ENVIRONMENTAL HEALTH DIVISraN <br /> 304 FAST WESER AVENNUE. IRI]FLOOR <br /> b'3Cyc.nam cA p2 <br /> )40-3420 ` l <br /> PU5LIC RECORDS ELEAS APPLICATION <br /> �y. <br /> AMMSS I <br /> PHONE - <br /> FA�MU <br /> TENTAYrVV�+pm-mrmENr oAT& T3 <br /> ($! 01"T to pl }e t7�sltlsaL n y*ft m eats i apoiPwQx agbRSlttat) <br /> CHECK a0X Y0 IXPEMI`rE�Q�aT-Sta.flo Fes-.Rt:�Y pR0CnS IN 3 9ai1 INES9 CATs <br /> SIGNATURE(?f APPLICANT _ DATs_ <br /> FI1,1:AGIystL`.S9 <br /> � � L <br /> °-3 La o <br /> y <br /> r 0 �. <br /> Y <br /> � c <br /> ENVIRONMENTAL HEALTH DIVISION 1=11.1:1 <br /> *UNDERGSLOtIHb TA19K;f IT)CLTcAMP 9fTB tLOPI O HOUSING At3ATl E R SOi to WASTE FACs1.1rY <br /> Cr OAR CLEANUP SITE tNON-LOP) a I:001)FACILirY 0 so•.D W"-M VElascLa <br /> VC tJMERGRCUHD TAi1K tasOWTOttilteft05MA14 Q OOG MEMN=l. Q MAY <br /> TCilAZARWtA VfAWM s19W.rtla-MR 0 cs VXEN RANCH ❑ PKS TFMATMENr PLANT <br /> C *nVtF-0PWW1j1 FAMIJ-Y R MOTCLOHQM 0 PUW19RTRU=YAR=FiE)WTDIE.TS <br /> ❑ -rA7T00WDY PG=IMG 13 POOLIS:A D LAM USE APPLICATAW SITa=S <br /> d vF-IXCAL WASTE r'ACU ITY 0 PURUC WATER SVS l M D OTMIXtMEARVEPEWY ABOVE) <br /> 't. L.13t up to tan Addreasan in the sgllesr atom Salad the tyWs)of files flan tho ilst above by chackin8 <br /> the appropriate box(es). At least one flea type MUST be elected_ F-g=(209]AOR138 arman iv the <br /> 2. END wets notify th*appliewit It any E}{p files exist. An m ppolniment for ravlaw well b4 eoriffrrned <br /> appra 1ma'tely five bWriass days twt no latter than tan 10)flays aiftiat reWpf of application. -no files <br /> will b9 hold for a maximum of five busirt [Lays f*r(008W, Is ppointmants ahotgd to ltcheduled <br /> accordingly. <br /> 3. A fila that is artiv*ly baing Workad on b7 EHQ staff may not be thw ttfiately avalsable for ruvir w- A new <br /> &PPlication May ba sulxnittrd when the Me is auatUble. <br /> 4. Any fete not returned In th&Beene eondW*n ea r*10480d Will Lm reargantz"by EHD'ataf at:the expense <br /> of the dgpiiearnt. Future file reviOWS by We tame AWicmt may require a$78.00 depasit prior to tevlew_ <br /> 5. 'TENT•At,IVE appotntrsrent date3 must be confirmed with EHO stvO. <br /> s, Appiicatlon9 recslved attar 3:oa pre will be processed tile next busiltsiss day. <br /> CONFIRMED APP=Tmen DATE 71Nr <br /> ! <br /> DATE CONFIRIViEt3 PHONE FAX 1MMALS <br /> REVIEYVEG YES NO fMlffW DAM <br /> 00„ m <br /> TJ)TX PIM <br /> �r <br />