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• ..r �. v �,..� +.lAr'4 v4.lAL4Ilily "' Uri1 T <br /> NOV Q ZO11 ENONMENTAL HEALTH DEPARTMEN .- <br /> L-,,,_tast Main St. Stockton, GA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-Cl 138 Web: www.Sigov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kdj&'X <i BUIS INESSIAGENCY: <br /> ADDRESS: CiTYISTATERIP_ �t}� X24 <br /> PHONE(1): (916a 4k-014 _ PHONE(2): 3 584, FACSIMILE-�gtle�Kto- 0110e3� <br /> TEN A� Tl(/-r'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application sub Itta1-"Tenwive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU T 122 PEE(CASH OR CHECK ONLY)-REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 DATE l0 3i <br /> Electronic Information. 71st❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CityUnit_1 <br /> 1. Ilo�o vwtue F <br /> 2. (bzLA A •6 A AIAI! �. 0 unit2 <br /> 3. <br /> 4. <br /> 6. <br /> -- Unit 4 <br /> 7 <br /> 10. <br /> Unit 9 <br /> Specific Data Rang of Informatlon Requested: From w- to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> b2' oERGRO0ND TANK(UST)CLEANUP SiTE(LOP) El HOUSING ABATEMENT OLID WASTE FACILI7YIVLHICLL <br /> 5?JHER CLEANUP SITE(NON-LOP) ❑FOOL)FACILITY 21 E FIRE <br /> FIERED <br /> ' ERGRovND TANK(MONrrORINGIREMOVAL) ❑DOG KENNEL y <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH t_-fWA TEWATER TREATMENT PLANT <br /> PERMITTED FACILnY ❑M ELIHdr>L PER TRUCI[lYARDICHEMiCAL TOILETS <br /> ❑ <br /> 9TATTOO/BODY PIERCING LISPA 3UND USE APPLICATION SITES <br /> -1�EDICALWASTE FACiLITY1rj{1THER(PLEASE SPECI Y) A"-k c o,.As p �K�roK�����j r . <br /> WELL AND SEPTIC PERMIT RECORD$ARP AVAILABLE FOR REVIEW: MONDAY-FRIDAY a:00 AM-5:06ta� H <br /> PM(ExCLUDING HOLIDAYS) <br /> 1. List u to ten add see In the space above. Select the types)of files from the Ilst above by checking the appropriate <br /> box(es). At least ane file type MUST be selected. Fax 2 4 _ 7 r I ated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 5:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD flies exist. An appointme t for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold for a maximum of nvo business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file la available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit F rior to review. <br /> !kD USC ONLY <br /> EHD 4a-0e <br /> 0>lY9N0 <br /> Ioor(ool xv� 6E: Lo � ozrzorll <br />