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SAN JC UIN COUNTYPU13LIC HEALTH SFICES <br /> ENVIRONMENTAL HEALTH Dl <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> JUL 0 3 Z00� STOCKfON CA 95202 <br /> ENVIRONMENT HEALTH (20%)468-3420 <br /> PERMITjSERVIGES PUBLIG REGARDS RELEASE APPLICA ON y-y� <br /> APPLICANTr ISUSIXESSIAGENCY �\Arnn 1 f �` <br /> ADDRESS <br /> P110ME FACSIMILE <br /> TENTATIVI6 APPOINTMENT DATE TIME <br /> EPlease pita T to 00 6sirless days from date at aPplicatien svbrnittal) <br /> ED CHECK BOX TO EXPCOLTE REQUEST-STILOO FEE--REQUEST PROCESSED lig{1 BUSINESS DAYS <br /> \IPIGNATURE OF APPLICANT DATE 2—J154111-0 <br /> FILE ADDRESS '1 Hm SIDE 3EKD 'AFF USE ONLY <br /> FROGR1►14t ELEIYtF_htT$SFARGli <br /> O% W, 1'. lAAY rev Wa e_kr*A 3S: <br /> i <br /> 6 tnca 0 5T. Cbct0A •5 <br /> 6 KK fc�ly 3`6l 3S <br /> I ! , t r Wa " ;5s Z f_:j <br /> a 15 W Gkar tc✓ w 3 a.. �, �� 23 41 35 Z io <br /> Ol W . Lavin, ad i 35' �5 lL a� l 3{-aZG 3 Z <br /> ao 1J r CnaVt STMT t <br /> li <br /> EhtViRONMIlNTA]_ HEA.1-'fH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(IAP) J7 HOUSING ASATEMI=JET ❑ SOLID WASTIE FACILITY <br /> a OTHER CLEANUP 5175INON-LOP) 0 FOOL)FACILITY ❑ SOLIDWA$TEVEHLr.LE <br /> a uN0ERGROUNO TANK(MON PT4RINWREMOYAL) 0 DOCS KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WAsTE GENERATOR M CHICKEN RANCH ❑ AKG TREATINSHT PL/;W <br /> 0 TIEREDPERIAMEDFACILITY 13 H101'ELIHOTEL ❑ PUMPER TRUCKIYARDIGHFAITQILVS. <br /> 'JATTOOlBQDY PEIRCING a PDOUSPA M LAND uSE APPucCAxjoN srrEs <br /> R N1 TTO I-WASTE IRCINGFACtUT ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPEGIFIFADOVE) <br /> 1. List up to ten addresses in the space Above. Select this type(s) of files from the list above by checking <br /> two appropriate I)OX(es). At least one file type MUST he selected. E2-,g to {209]4�4-013$or mail#a the <br /> ad indicated a ave. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confiran� <br /> approximately five business days but no later than ten(10)days after receipt of.applieatlon. The files <br /> will be geld for a maximum of five business clays for-review. Appointments should be scheduled <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application maybe submitted when the file is available. <br /> 4. Any file not rotnrned in the same condition as released will be reorganized by FHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> s. 'TENTATIVE appointment dates must be confirmed with EHD staff- <br /> 6. Applications received after 3:00 pm will be,processed the next business day. . <br /> FOATE <br /> ED APPOINTMENT DATE - TIME <br /> IRMED PHONE FAX WITIALS <br /> �F_VIEwal Yet W6 ftEVIEW DATE TOTAL P.01 <br />