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09i 25/2x00 11:53 209450 3 FIFTH P-DOR �� PAGE 02 <br /> SAN JaAQUTN COUNTY <br /> PUSL 7C :iBA.LTR SERVICES <br /> BNVIRQNMENTAL HEALTIT DIVISION <br /> PUBLIC RECORDS k8LBAS E APPLICATION <br /> hPPLICUIT cil` i �_ .f�_r, A LA.LI ;. _PHONE NO 7�Y/�3�-�' <br /> An�tz ss i 00 04--j-e � I ek c_-e , �c�_ L-r4 B 2n - } <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FULL ADD2PSS BUS "JsSS NAME/ PROGRP-M OR <br /> �'AC:Cl. yoy 'T'YPE OP FTE R <br /> ase d s <br /> -AW �" y <br /> THIS NOTICE 13 SUBJECT TO THE REQUIREMENTS JC7ENTIFIEO IN THE FURLIC 1-IEALT'ri <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EH01 POLICY .x94-007, ORDINANCE CODE OF <br /> SAN JOA.QUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A VIAXIh1UM OF TEN LLO-1 PREMISE ADDRESSES P5R REQUEST <br /> 2. PUBLIC FILESiRECOMS REVIEW 1S 13Y APPOINTMENT ONLY. APPOINTMENT$ ARE PRO'CE'SS' <br /> ED BY CALLING 12491468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> T`HRU FnIC)AY EXCLUOING HOLIDAYS, 8.00 AM TO I2:00 NOON AND 1:00 TO 4:30 PM. <br /> 2_ A PUBLIC FILES/RECORDS RELEASE APPt:CATION (PARA) IS REQUIRED. <br /> 4. PUBLIC FII_ESIR5CORD5 NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> COR ECTEO BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAI„ <br /> SERVICE VALL BE BILLED TO THE APPLICANT FOR PAYNIENT_ (SEE EHI7 POLICY 94-0071 <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> .......... ........***........ .J TTT •r YA♦rrw .+.++r4.r�..T+ .,..���..�.T <br /> SIGNATURE OFAPPLICANT DATE /�� <br /> SIONATURE OF RELEASING OFFICIAL DATE < �jU <br /> EH 00 }4 (REV 9198) <br /> Z0 39VA VGL9Z694IL II:ZI 000E/SZ/S0 <br />