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LVVD ii;4t3 FAX 770 842 0257RUT INC. ATLANTA <br /> 16002/002 <br /> r 66/24/2665 07:50 46461 ENVIR01`I�NTAl_ li-1 <br /> - � PAGE 01 <br /> no S <br /> ������� � o ANJoAr�vW CoxrNT� . <br /> N14 ,ENTAL UEAX•TU DXPARTumm <br /> � + 2 93 ?_005 `Tel honet(209)468-34 d Fax:(209)Floor,Web"Avenue,3d '464-01388 Webbwww4 ov.og ebd <br /> { p#4f, i=PtT HEALTH. <br /> PUBLIC ncORDS R LEASE APPLICATION <br /> /PPIJCAN[T; ns-fine01 8U3lilM9rAWCY: In c <br /> ADDRESS. f 0 U S e. 5 i e I oaklahta, &A 30350 <br /> PHONE(t}: -9 5 to X149 PROMEM. <br /> (t}: Acsla _`ll b-(O42-02 a <br /> " Q �°x Tl;NTATIWE'Appoa+rr>vrENT naTs: 1 2 0 5 r� 9,0 <br /> (Pleas"allow 10 bialnom days from date of man submktal-*TeMpO a-only-must be <br /> Oa' C1 cm=sox Ta mCp6DITE RWU •$g9.oc FEE OR CHEM ONLY}-PZ-CMF PROOMEniN 3 BUB�I S MYs <br /> SIGNATURE OF APPLICANT U-- DATE -&/2S/05 <br /> UNIT DISTRIBUTION G Unk i M Unit x g#WALjffr9t4 O Unci s O Unite Q <br /> F"ADDRESS EHD USE ONLY <br /> ,break i Sheet tisane city (Rhe <br /> 1. 5 eS4 OIV 71 <br /> 2, e o r <br /> 6 <br /> 3. PIERO <br /> 4. <br /> F <br /> 7. <br /> •epertft Date Ral+ge of Into n7atiod Requestedr.Frratn:--_ 191 a In 005 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y�11a 0UNo TAKK(U"0LEru w Sm Q OPI O Nomm AhATfir mT 13SOMWASMFACUYYNOME <br /> �dl Onm Cl.s Opp srrE(NON4.0P) G Food FAcEmr o WASH TIRE <br /> (Ur GWMJ lbt•AuK(eA*4rMWJRMt*VAL} anos:NORM 13 DANY <br /> JS kUAR0068 wASM GOERAl�le D aacxaare RAreai Q wASTEYYAt�1tTR 1 aMT PLAW <br /> E3 Tib P FACUW t] iGiEL C PL7 TRUCWA bK MTQ1 $ <br /> 13 TATroOfBalm PVf+tts4to 't]POOUSPA .i7 L"Ilse A"UCa1"M SITS& <br /> 01AImr.ALWAMr-ACa.ITV a on=VVASESPE�FY} <br /> . VrFLLJ111D�'IIC�EffRECONCSARE/lVasaaeFQRAEVISIM- bQNdAVFR$'YIY�:40�LM��QOPIr � �OL�YS. <br /> 'l. List up to ten addresses In the space above. Select th4 type(,)of files from the lint above by the Wng the <br /> ,appropriate box(es). At least one file type MUST be ssseleated, Eax.to(2"1044138 or m;g.0 to a address <br /> Indleaftd abav®. Address ranges will not be accepted—for additional assistance with file add msses,contact <br /> the EHD.Applicadonsrecelved after 3:00 pm will be processed the next business say.' <br /> 2. The EtD will atiottfy the applicant If any EHD files+'exist, An appointment for review wig be confirmed <br /> appro)dlnately ten(10)days after reCetpt of application. The fines wUl be held for a maximum of five business <br /> days for inview. AppointMents should be scheduled accor'd'ingly. <br /> 3. A file that Is actioaly being worked on by EHD staff may not be Immediately'available for review. A new � <br /> application may be submitted when the file Id available. h <br /> 4. Any file not returned in trio same condition as released wilt be reurgantzed by EHD staff at the expense of the <br /> appiteant, Fututt fele reviews by the same applicant I;nay require a$93.00 deposit prior to review. <br /> I <br /> �i <br /> i <br />