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USAN .1OAQUIN COUNTY <br /> t'l1ItI,IC IIFALTII STRVICFS <br /> F,NVIRONMF,NTAI. IlEAuni DIVISION <br /> I'LIBLIC RF(,ORDS RELEASE APPLICATIONI ,. z,ti T <br /> APPLICANT_1400,an 4 A�SctiL PHONE NO 2D9 �rw�z2oo <br /> ADDRESS 2L5 10• Dck..+_•- <br /> AGRNCYNAMR PHONE NO _:)O"I 3`1 `C 2.2oU <br /> ADDRHSS�.1�«)• perlh+ . (I Ca`-` 5.---, G� �SCof i <br /> 11LE ADDRESS LEAD-AGENCY / VA' <br /> i) �1 _- -- {t - . - •�IAYMENT <br /> FEIV <br /> l cn Cav p __ J1-1-)-) s • me t1o.�-,- '1 �ECED J <br /> K <br /> -G n e <br /> -��.� s - mc u�."` — <br /> 4 -ts,= -r�v-1993 <br /> c;U,INTY <br /> s 1.98 )• 1y'Zc Wau-� P(18N6 HEAtfih SFRVICES <br /> _H - P • 12_0111�.,� �,� " 01 V S Rj I+ t Ms•.M ENViRONMFNTA' HE LTH DIVISION { <br /> -4 <br /> -1111S <br /> — <br /> �8 Rvlor�t Sc�(.l� 287 8 e- UNre�- i <br /> 1111S NOTICE IS S11B)F(7t' 'T'o IIIF RFQUIRPMFN-rs IDFNTIFIED IN T1tE PUBLIC HEALTH <br /> mnn V1dR11tnNVInONMRNTAI.11FA1.1lt hl VIF10N (Fill)) POLICY#92-007,ORDINANCE COOB OF SAN <br /> 3OAQUIN COI)N't-Y. EHD FFFS AND SERVICE CHARGF RESOLUTIONS, STATE WATER CODE, <br /> (',OVERNMFNT CODE AND T)IF EVIDENCE CODF. . <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILFSIRFCORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)469-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY TIIRU FRIDAY EXCLUDING HOLIDAYS, 80)A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> 3. A PUIILI('RECORDS REI.FASF; AI'I'LICA'I'ION ANDA NUN-REFUNDABLE DEPOSIT OF 578.00 <br /> IS REQUIRED. I)EPOSITS WILL TIP RR111RNFD TO I IIT. APPLICANT IF TIIE FILES/RECORDS ARE <br /> NOT AVAILABLE WITIHN Tl1E ctmzrom OF TIIF. [IID. <br /> 4. INE ABOVE IDENIIFIFI) DFVOSIT IS APPLIED TOWARDS 111E TOTAL FILE REVIEW FEE <br /> 3 <br /> ('IIARGE. 'IIIF BALANCE OF TIM CIIARGES ARE DUF AND PAYABLE PRIOR TO REVIEWING TIIE <br /> DOCUMFNT(S). <br /> 5. PUBLIC FII-ES/RECORDS NOT REIIIRNED IN 111E SAME CONDITION AS RFCEIVED WILL BE <br /> CORRECTED BY TIIE Fill) STAFF A'1' THF. EXPENSE OF 111E APPLICANT. 1111S ADDITIONAL <br /> SERVICE WILL BE BILLED 'I'0111E APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIREC(MDS SIIALL NOT BE REMOVED FROM III FHD PREMISES. <br /> SIGNATURE 01: APPLICANT _ - (� , JL ct l J DATE 17 L�$_143 <br /> 51(;NA'IIIRF 01'I0i1 EASING; 01:11( 1A1. DATE <br /> 1:11 00 14 (REV 12/92) <br /> ) <br /> - 1 <br />