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' r <br /> BEFORE THE BOARD OF HOUSING APPEALS OF SAN JOA - <br /> APPEAL FORM <br /> San Joaquin County Ordinance Code Section 8-5005 SEP 2 4 2020 <br /> In order to be valid, a written appeal and $78 fee must be received by thefoHEALTH <br /> orICES <br /> Health Department within thirty (30) days of the notification of the violations Plan r <br /> payment. <br /> (SJC Ord.Code Sections 8-5102,8-5403, Board of Suuppervisors Fee Order B-92-1591) <br /> Rej <br /> Date: "� � ' �� Premise Address: l 2�2 S�c j z PG2 <br /> a 95 �S <br /> Appeal by: _ � )-C-0 ", 0-v� Phone: 2-6-'lI I y- ( q3 (x <br /> (type or print Ilant(s)name(s) 1 <br /> Mailing Address: C1'L2Z C /AE,C6 t' 0,5 C., j�2-3 <br /> Legal Interest in Property: [property Owner ❑ Beneficiary❑ Lien Holder ❑Person in Possession ❑ Tenant <br /> Type of Relief/Appeal A-C,,� *L OCA 3 <br /> ❑ The findings of violations, the findings to vacate, or the findings to relocate tenants by <br /> the San Joaquin County Environmental Health Department, as documented in the <br /> Notice dated <br /> San Joaquin County Ordinance Code Section 8-5102 <br /> ❑ The Statement of Expense for San Joaquin Count Env'ronmental Health Department <br /> inspection and enforcement costs dated 2- <br /> San Joaquin County Ordinance Code Section 8-5401 <br /> Give a brief statement, in ordinary and concise language, of that specific order, violation, or Statement <br /> of Expense protested. -TV\ 0& s Y-e—j 0,j i �rl� 'F-� c)- <br /> e*\kp� A-c_-J i V�d of c k e��r3,�,� o�e� 4c-v r-d i <br /> Give a brief statement, in ordinary and concise language, of the reasons why the protested order, <br /> violation, or Statement of Expense should be reversed, modified or otherwise set aside. Provide any <br /> material facts that support your statement. TV)�S \-IeU✓ I10— n c 1x� vj eu Sy <br /> LA S V\/e W-ey< D cA e.-e-a/ C>1 C'-y S 3M C C,r✓-P L C, V, V"'k, <br /> �tJe d ti%hrc�k vv �y s a s v s �, ► ; 3 c d <br /> Give a brief statement, in ordinary and concise language of the type of relief sought. <br /> Cairti Y2� CS�- '� v-c-d fit' c-2 <br /> ai <br /> Applicant's Signature: -a Lc_Date: 2-< ) <br /> I CERTIFY UNDER PENALTY 0 PERJURY THAT THE FOREGOING IS TRUE AND CORRECT, <br /> Mail or Deliver to: Board of Housing Appeals of San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue <br /> Stockton, CA 95205-6232 <br /> For assistance call (209)468-9674 <br /> Date Received: Program Record: <br /> EHD 13-XX 04/30/2019 BOHA Appeal Form <br />