Laserfiche WebLink
SAN J( )UIN COUNTYPUBLIC HEALTH Sr-, VICES � ���} `� +.► � <br /> L�VIRONMENTAL HEALTH DIVISIG. <br /> 304 EAST WEBER AVENUE,THIRD FLOOR APR 2000 <br /> STOCK'rON CA 95202 <br /> {244} 463-3420i=1'��IhC'I`JI�fiE(�!1AL HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PEWr41T/SERV!CES <br /> APPLICANT YJUSINEMAGENCY (itULJQl1 [nlJ [1 D4✓'U�kv4Imen •`enc" <br /> ADDRESS ! QS C �!J SrOS~ <br /> PHONE �D 7(p 1 �!z(o FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from data of applicavo!�u mittal) <br /> (earl Ler She-f`r ha S ()r t o r iI"T H pjP bDP 1 tLt <br /> *CHECK BOX TO EXPEDITE REQUE $78.00 FEE-REQUES ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> E ADDRESS <br /> !t s <br /> a I EI <br /> 5- 02 7- CD - <br /> Can STO <br /> 4- w <br /> 1 UL <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IX- UNDERGROUNO_TANK(UST)CLEANUP SITE(LOP) r-) HOUSING ABATEMENT C7 SOLID WASTE FACILITY <br /> qZ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLI= <br /> JI. UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR ❑ GHIGKEN RANCH ❑ PKG TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS <br /> ❑ TATTOC7BODY PEIRCING L7 POOUSPA El LANE)USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to ten addresses In the space above. SeleCt the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later then ten (10) days after receipt of application. The files <br /> will be held for a maximum of five busiDQ5$ days 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 may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD 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 /> 5. `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 /> F <br /> ED APPOINTMENT DATE TIME <br /> IRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14- Q'11DYD0 <br /> 12 1 <br />