Laserfiche WebLink
—MAY. 18. 2004- 2:08PM -"JTGOMERY WATSON --1 NO, 923EHDLp, �urnBER <br /> DATE RECEIVED �� SAN JOAQUlTT COUNTY \�► <br /> `° (� �'I��;��� ,� FWMONMENTAL HE• LTU DF-PARTME T <br /> 304 E Weber Ave 3T1 Floor Stockton, <br /> MAY 18 2%)468-3420 Fax- (209)464-0138 Web: wwW.CO-Saa-joaqi-un.ca.us/ehd <br /> TH APPLICATION <br /> j,dVjj��-c)`IMENT HEALPUBLIC pB : A <br /> BUSINESSIAGENCY: <br /> APPLICANTtef, <br /> t <br /> ADDRESS: V' �V <br /> g�� <br /> FACSIMILE: a 6 v LS <br /> PHON>w; 6 �' J <br /> Time: � <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Pleas®allow,10 business days from date of app <br /> Rcation submittal) <br /> CHECK BOX TO EOCPEDrrE REQUEST-$93 00 FEE-REQUEST PROCESSED 1N 3 BUSINESS DAYsDATE � <br /> SIGNATURE OF APPLICANT 40eDMm,(t Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. s r 3 00 1 c -boG� o✓� o'� ❑ Unit 1 <br /> G <br /> 2- s 5 L Unit 2 <br /> a. a S 1.. r G PK, <br /> c <br /> ISO <br /> s. sa9et Z _ Unit <br /> 7 J-700 AJ n dp <br /> t c� <br /> a, s�t � Unit 5 <br /> 9. <br /> $ at �� <br /> I <br /> GL <br /> O, SUeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILrry <br /> $( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E2 FOOD <br /> FACILrrY ❑ SOLID WASTE VEHICLE <br /> a OTHER CLEANUP SITE(NON-LOP) Cl DOG KENNEL ❑' DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR p M KEEN ANTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> JOL❑ TIERED PERMRTO FACILITY C3poOUSPA In LANP USE APPLICATION SITES <br /> 0 TATr00/BODY PIERCING ❑ OTHER(PLEASE SpEClfr"1� <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> the appropriate <br /> address indicated above. ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An 410 days after receipt of application. The files <br /> approximately five business days but no later than ten( ) y <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. n®� <br /> application may be submitted when the file iS available. anized b EHD staff at the expense <br /> 4• Any file not returned in the same condition as released iitl be may require a$93 00 deposit prior to review <br /> of the applicant. Future file reviews by the same app i <br /> 5, *TENTATIVEdates <br /> i <br /> th EHD staff. <br /> 6. Applications received after pm will be processed the next business day. <br /> f 1�'m��•C'+Q �' I �t .�� , r l '4 • „ `"� •'�•• ' ".k. ,,�` Ar' . Y Y• '` J <br /> T•* IR'`-T�, X64 • Kr Y .a� ,�R1 `Y. �, • � fl t�•:, Y. „' J•iY,' W� �... { .M�• <br /> ;.PAx'. <br /> CbNlriFltl:p ,: ,'. ;+ S �;.'• �.I ;» ,� �• <br /> DACE r +y,. REVIEW <br /> P XVII WIC <br /> LHO 43-02.006 <br /> 9182003 ` <br />