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- <br /> r aye <br /> •"i >r ' I O ' $IAN JOAVUTY •COUWry <br /> PUBLIC HEALTH SBRVICI;S <br /> I !ERiVT11QPII+lYN�SA1+ K ALTH DSVIBIWY <br /> p1 LIC R13CORD8 Rn rSAms APPLZCJ mom <br /> APPT�ICAN'i� SuE ���ioE'7E (� —PHONZ 140 <br /> 4nBpCYSNAME p1 S NO V - 7 0-'Z- 1 <br /> f W11 [h1 <br /> ,xonass � ' <br /> � ara���i, Nares/_ n�c3r+�nn,r.�g <br /> U i^!AB OF Fri <br /> q �o1 "jam t�acfrw LU•ST- <br /> T <br /> i <br /> I� - <br /> r <br /> D <br /> ••* t***#**Yid««««#*#«*X+4•«4+«+«R#«««+«,«••�'r•I.►trii b««iii«++##!##'�# ; ' <br /> THIS OT10E'14 $UR,aiGf TG YHE.�}E¢UU{4MENTS IDEN11PIED IN THE PUeUC HEALTI{ <br /> 9ERV ICESIENVIRONMENTAL HEALTH DIViS10N lEHt)l POLICY 894.007, dROINANCE OOE OF <br /> SAN IOAOUfN CQU(ifY. QMD FEE,AMU 5&vtCL' CHARG9 RESOLUTIONS, STATI VVATdA CODE, <br /> (;OVE'RNMENT CODt AND*TI-IE EVIbiN(:S CODE- <br /> 1. A MAXIMUM OF�'t ' PREWSE ADDRESSES PW REQUEST <br /> 2. In Fsuc Fl4ESMIN:OAD� RIIYIIYYE.is �1': Ys APPOINTMFNITS ARS PROCESS- <br /> �p CALURG 120!;11469- '2D. OFFICE MOUAS�PVOIMTMWwrm TARE SCHlfDUL!1] MONDAY <br /> THR FRIDAY KJ�d.(1DINld HOL11)AA'1`5: elOO'Atui TO 1 Z00 NOON AND 1:00 TO 4r30 PM. <br /> 3. A PVOLIC RLL-WAECORD6 REL" APPWr-ATW"* IPRRAI If H60U"9 - <br /> d. RIJC Ptl!?f}RECC111D5 ROT ftETUF1NEDIN THE SAME CONOITWN AS RGG81VE0 VWU BE <br /> r,GRF ECTED BY.TM8 EHD STAFF AT,THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> 3ER CE WILL BE 91�1 Eb fi0 THE +(PPUC�4NT FOR PAYMENT, l5EE SHE) POLICY 84-00-71 <br /> S. 01 41GINAL.PUBUC Fi1.69mucORDS SMALL NOT BE REMOVED FROM THE EMD RREMI9B9: <br /> SIGN TUBE OF APPUCADATE <br /> SICNATUR£ OF PfidASINQ OFFICIAL <br /> '' DaTE <br /> 7 EH'00 14 (REV 9198) <br /> { b.'ai <br /> TOTAL <br /> i <br />