Laserfiche WebLink
11/18/2005 10:45 FAX . . Ia002/002 <br /> SAN JOAQUUt Co l"aY <br /> _ NVMoNMENTALHEALTHDEPARTMMNT <br /> 304 E Weber Ave 3d Floor Stocktoo, CA 95205��ehd <br /> I j d 1 R N05 (209) 468-3420 Fax: (209) 464-0138 Web: www�Do•sauJoh„ <br /> E.NVIr3ONMENT HEALTH <br /> PERMIT/QSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> nI,F _9usINESSIAGENCf: r` "� <br /> � <br /> APPLICANT:_Aar-�'�--” S to C <br /> ,z <br /> ADDRESS: 2t7� 8" 21 <br /> FACSIMILE: <br /> PHONE: <br /> TENTATNE APPOINTMENT DATE: <br /> (Picas.allow to bv:+ness days from dace of applicadon suhmhtai) II-IL <br /> ❑ <br /> ITE REQUEST- 1.00 FEE—REQUEST PROCESSED IN]BUSINESS DAYS <br /> CHECK BOX TO EXPEDDATE <br /> SIGNATURE OF APPLICANT Depanm Mt Use Only <br /> UNIT <br /> FILE ADDRESS Un <br /> i1 <br /> Un2 <br /> Unit <br /> 0'] <br /> a <br /> Unit <br /> T. <br /> Unit 5 <br /> ` <br /> �• str�n Y <br /> ta. Sexd A �dl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UL SCUD WASTE FACILYIY <br /> ST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(U :)N 0 FOOD FACILITY 6 DAIRY ' <br /> OTHER CLEANUP SITE(NONrrOP) ❑ DOr I¢NNEL <br /> ❑ CHICKEN TtANCH 0 FUMTREATMENT PLPNT <br /> M UNDERGROUND TANK(MONrrOFtING1REM0VALl ❑ PUMPER TRUCIUYARDIGHEM TOILETS <br /> Z HAZARDOUS WASTE GENERATOR ❑ MOTEth10TEL LAND USE APPLICATION SITES <br /> ❑ TIERED PERMrrrED PACILrIY ❑ POOLISPA ------- <br /> U <br /> ----1❑ TATTO018OOY PIERCING ❑ OTHER(PLEASE SPECIFn <br /> ❑ MEDICAL WASTE FACILrTY <br /> List up to ten addresses in the space above. Select the type(s) of files from the list.boys by checking <br /> �. a MUST be selected. Fax to 209 4640138 ar m <br /> _ the appropriate hox(es). At least one file type <br /> rned <br /> address indicated a PP e, Y for review will The files <br /> 2 EHD will notify thea licant if an EHD files exist to appointment10ointments should be scheduled <br /> approximately five business days but no later than tan (10) days after receipt of application, <br /> will he held for a maximum of five business days for review. App <br /> accordingly EHD staff may not be immedlately available for review. Anew <br /> g A file that is actively <br /> submitted when the file is available' <br /> application maY <br /> licant may require a $93.00 deposit prior to review. <br /> q Any file not returned In the same condition as released will he reorganized by EHD staff at the expense <br /> of the applicant ointmentture rile <br /> dates must hethe <br /> canfirmed with EHD staff. <br /> 5. •TENTATIVE apP <br /> 8 Applications received after 3:00 pm will be processed the next'business ay. <br /> ..TIME '.^ e;.• .� .-,,.. '.._ . <br /> '. ONEE�ht � A • k ,. . r iNF{IPt s <br /> Df+T .OzQNFJRMED, REVIEW DATE <br /> REVIEV'!ED YES NO <br /> l5T t75 : OIQ�.jiA 11971� �f)aP>'• I'35 r" <br />