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1 rl—1 4—1 y�I 1 Y!=µc.�rV•t t n4J1.1 nu._. i w cw ..n.+. •...w <br /> `r/ <br /> S bN JOAQUIN COLTAN l-Y . <br /> PUBLIC HEALTH SERVICES <br /> EINVIROIti MN TAL-F3EALTH D z'VI,SION <br /> MYBLIC RECORDS RE LEASE WFLICA.TION <br /> APPLICA,NT` 1�v_c t ie rsor. PHOrTEria (209) LI6 7- i do(0 <br /> ADDRESS <br /> AGENCY NAME 4&jMtjtctc) GMC y�� cK'f�� PHONE NO <br /> ADDRESS -YDozo 5 <br /> •FILA ADDRPS--1 T E6 DNT Y IDATS <br /> 3225 6*1-00+11er R.1.� _ P its- Et}D <br /> -- <br /> ZBSd L&#*%ts R• ad) <br /> 2*60 T"P4 1; 3 s•2 F� c.-' <br /> 2191 MAdtosk 2 d C&} 3 _�.__ <br /> 2Z 73 444ir •3a 35- w <br /> .7 /Y <br /> • 2 40 mL. <br /> TI-IS ;NOTICE IS SUEJF_Ci TO 1-H6 REQUIPLEMENTS IDENTIFIED IN,' THE PL'ELIC HE-AL'I'H <br /> SI::Rt7ICESlENVIRON\IENT AL:?EALTH DIVISION (END)POLICY�,92-007, ORDINANCE CODE OF S:LN <br /> JOAQUIN COUNtTY, FJiD rS S AND-SEAVICE CHARGE RESOLUTIONS, ST.ATF_ WATIik CODE, <br /> GOVE-P-NME;lT CODE A.NID ir.E EVIDENCE CODE. <br /> I. A hl'A.-UMUM OF TEN (IO) P.REM3S= :ADDRL-SSSS PER REQUEST. <br /> 2. PUSUC FILESIRECORDS RGVIL',u ,:RE BY APPOINTME- O\LY. AP,POI\TMENTS ARE. <br /> ARR-ANGED BY CAI-U,-,G OFFICE POURS FOR APPOINTMENTS ARE SCHEDULED <br /> M0jNDAY TR.gU FRIDAY E�CL(JDING HOLIDAYS, 3:00 A.M. TO 12:06 NOON AIND I:UT P-"%l- TO -::30 <br /> 3. A PUBLIC RECORS7S ,:LEASE APPUCATION ASD A N01•REFU,'nAr1_EDEEOSIT OF 573.00 <br /> IS REQUIRE--D. DI---POSITS A.LL BL Rlrx'1.IRNED TO THE APPLICANT IF THE FILES/RECORDS ARS <br /> -'OT AVAILABLE WITWN l i CUSTODY OF THE END. <br /> s. TRA ABOVE IDL-NTIF)ED DEPOSIT IS APPLIED TOIVARDS THE TOTAL FILE. REvFlEW FEE <br /> CHARGE_ THE SALAINCS OF il-IE CHARGES ARE DUE AND PAYABLE- PitiOR TO REVII:NVING THE <br /> S. PUBLIC FILE—SMECORDS NOT R.FMRNED IN THE SA.MS CONDITION AS RECEIVED NVILL BE <br /> CORRECITM BY THE E-HD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE.WILL BE BILLED TO THE AFFUC/4NI'FOR PAYNI NT. <br /> 6. ORIGINAL PUBLIC FiLESMECORDS SHALL NOTBE RENIOVED FROM THE END PREMBISS. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 lRF:V 12/90 <br />