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09/24/2007 17:23 13107" 41 PAGE 01 <br /> 04;�8 018y <br /> AN JO AL WEALTH PAGE: 01 <br /> 'frll <br /> SLP11A 4 2007 .QGQ <br /> N1�r I C i`d � 'east W Aver ue,3n'Floor,Stockdoa,X4.95202-27 <br /> I7 i-^ /n� ne'-(2 09)468-3420 F":(209)4ti�4-Q).38 Wobr warw.sj�rav <br /> v!1� <br /> �,��LI <br /> PTBUC RECORDS REL <br /> R 1PriLT AhN . <br /> APPLICANT' �ltsEN�65fAt3�NICY: AF 1 1JSl►1 ..,: <br /> ADDRESS; ICA <br /> PHONE(1):� < � ' Co PHONES(x): F'ACSnMF- <br /> TEPITATIVE'"APPOiNTiYfEFIT BATE: C�C]'C1 f 'N f ® <br /> Mena allow ib business days frons dada of swicelion MbMlU21.*7VMwM ady must be sans M" <br /> CHECK BOX TO MEMM RMUEST- M00 FEE(CASH 0 .CFiECiS Ot .lf�-Ftl: PRDCty95ED pi 81st ISi �BAYS <br /> SIGNAfiURE OF ADPL �""� PATE -F <br /> �ectrania Irtforma"on: M.List 0 Mai,.-D crlptian: <br /> FILE ADDRESS r=HD USE ONLY <br /> Str+�t�F SbV*t Have <br /> . � h Q nl �V� � ® UniE i <br /> 1 <br /> 3. vL✓ ®c <br /> 4. <br /> ?F1*14 <br /> 7e <br /> 0 unit s <br /> S' urm 0 <br /> Specific,Doft RwMe of InkrinaflQn Regnasted:Fmm _ tt. AV/�� to <br /> ENWROMMENTAL HEALTH DEPARTMEW;rmv <br /> TAW(usi� elm(LOP) t7 Nvo5 O ABA 0WAMFACci4TWE"M <br /> SErE a qP) t2 FM Thio <br /> TANKOVA) Ct UCGKoen � <br /> WAa78 t3 TC►E� t+TOMM RAM MMWA?ftT1"TMMT PL AT4T' <br /> FACL17Y a MMUMM OF FvmPr.R'i'{ wffAaw0wMTuRE'tY§ <br /> I ipNC Ei poot M d LAND Un APPMAVON Me <br /> 19 tom,WAWM VAQLTTY 0 ra (PLEM <br /> W&LAND$EPTTIOPMO ARaAYAEiJ=Fft -VQtMAY-FRlIMAY'4'.Q0A+-9;00M -amwom" <br /> .. � IRAW�®191RIX1 iAReOYel.a .1�1. n+wle�. <br /> 1. List upto tan add ses In tho space above, th+s type(s)iDr tram"list above by chectdr1a the appmpriate <br /> box(es). At least one file typo MUST b®'saletdad. pax tn:t309}d.M. 128 ori_tb d a§gMss ((t�,ca# ibgirg Ada ass <br /> tanNes will not be occepW r for addif anal assist nco with til9 addresses,contact the END.Appliasuons recoWN after <br /> 2:00 pm vrill be pro¢essedthe next bushwess day. <br /> 2.-TheJEHllaAll noti"o-applicar t.If_any l)Slata qua-appolnimetafi -nMewYfill be <br /> days after recelpik of application. Tho foes mitt be hold fora iriaodrnun9 of 0"bWlnoss days for rcvlQw- Appointmaric <br /> -----should-b" Ey: <br /> 3. A flit!that Is aethrely batt worked on by EHO staff may not be immediately avaltabie for review. A now application may be <br /> submitted when the 011e to vmllabla- <br /> 4. Any file not returned In the swne condition as raleased will ba reorpnlzed by M staff at the expense of the 401110011L <br /> Futuro file revieuvs by tie saroo applieOnt may require a$95.00 deposit prior to reviaw., <br /> EHES USE ONLY <br /> q@ap-0p Att6 ' <br /> L <br />