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6-2_7_1 crab 3 - IJNPt•l P' AGF NG '2ULJ `_ b` <br /> rI <br /> SAN JOAQUIN (:OUN'T'Y <br /> PUBLIC IIEAL7'CI SMVICES <br /> ENVL-kWNMEN7'AL HEALTII DIVISIOPI <br /> PUBLIC RE' CORI)S RLLEASE APPLICATION <br /> APF'LICANI' T' MPF10NTi NO,— <br /> ADDRESS 18 <br /> PIION1Ei NO <br /> AGENCY NAMB S <br /> ADDRESS <br /> I?ll� ADC)12L'SS <br /> rev A�.>?Nrl PATC3 <br /> 3S. qs 4 L d <br /> o <br /> St <br /> '11115 NUTICE IS SUWECT T'U T'31E REQUIREMFN9:Sv1D1iNT111GD [ N 11111E fUI)LJC IIEALTTI <br /> St1RVICES/ENVIRONMEPI'1'AI - HEAL"I71 DIVISION (EH D) I'OI ICY N92 {IU7 . ORDINANCECOD8 �O1' SAN <br /> IOAQUItJ COIN"['Y. F31D FEES AND SERVICE CHARGE RESOI_UT70NS , STATE WA'1TR CODE, <br /> OOV t1RNLVIGTIT CODO AND TILE RVIDF.NCE CODE, <br /> 1 , A MAXINIUM OP TEN ( ID) PREMISE ADDRESSES PER RE(;UESI% <br /> 1 O IT O(J > �r _ APPOINTMEN'C; ARE <br /> 2- PUBLIC 1'ILE5/R ECCR .)S REVIEW ARP, By A P-P�N�Il�t(yl <br /> ARRANOEI) BY CALLING (20. ).168-0140 , OFFICE HOURS FOR AITOINTIVIFN'YS ARE SCHEDUIID <br /> MONDAY 711RU FIUL)AY EILC(`JDINO HOLIDAYS, 8 :00 A .M - .I.O 12:0 NOON AND 1 :00 P. M. TO 6:30 <br /> P. M . <br /> 3 , A PVBUC RECORDS RFIJ'. ASI : AI'1'UCA"IION AND A N_4d.-Ft >rl7�dUSIRE iU ARE <br /> IS REQUIRED . DfPUSI'15 WILL RE E(E` 11RNEU 'PD 9111E APPLICANT ` F T11L• FILES/RECOF.DS ARE <br /> NOT AVAILABL73 INUALIN THE CU5PODY OP THE EIID. <br /> 4 . 7141E ABOVE IDENL7DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW <br /> 1443 FFE <br /> FEED <br /> CItARGE. THE IIALANCli OP ' DIE CHARGES ARL DUG AND PAYABLE PKIOR 10 REVIEWIN/3 'LTIE <br /> D(E7UA4EN'1(5). <br /> g , GTLJRNL•D IN '11I1i SAMIA UUNDITION AS RECEIVED uILL BE <br /> PU9UC Ill-FS/RE� :ORUS Nall It <br /> CORRECTFD BY 111E EIID STAFF A"1 'DIE EXPENSE OF THE APPLICANT, THIS ADDI" IIONAL <br /> SERVICI? W11 I . RE 11111 ED 'CG 771E API'L ICAN"I' FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC I'ILH.^VILGCORDS SIIALL NOC DG REMOVED FROM THE FILL) pILE_M1SES• <br /> pATB t2 ` � 7. 4 l -• <br /> SIGNATURE OP APPLICANT <br /> - DATE <br /> SIONA•R1KR OF RELEA`;ING OFFICIAL - ---- <br /> �� H11 ( K) 14 (REV 12/92) - <br />