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SAN 1 UA Q U I N Environmental Health Department <br /> COUNTY <br /> COMPLIANCE SCHEDULE AND AGREEMENT <br /> LOCATION: 1 '�6 ! e�) O E, V V a I n ut.+ 5+. CITY: C �L}"U4"x+'S <br /> PROPERTY OWNER NAME: <br /> List activities needed to correct all violations and provide the date the activity will be completed. Provide additional specific <br /> information describing the activity:type of unsafe or unsecured condition,type of pre-permit activity (i.e. preparation of <br /> plans, asbestos survey/utility disconnect for demolition), type of permit needed (i.e. local building permit, well or septic <br /> permit,State Housing and Community Development permit), etc. Use additional paper if more space is needed. <br /> COMPLIANCE ACTIVITY COMPLIANCEDATE FULL DESCRIPTION OF ACTIVITY <br /> Unsafe Condition Securement <br /> Pre-Permit Activities <br /> Obtain all Required Permits ` c)k46e'Jw ���'�✓w� fs 'r �G� 11 VA L <br /> Repair/Demo Task r�rrv�U�-(= �1 vV1�;[� �•v► 1 f� �Q���v-� <br /> Repair/Demo Task e"V . 11sv VJP I' I trtc�c-1S E?�S�IL�, <br /> Repair/Demo Task i J �I r✓1 S��t-�� kv4' P LA-C, <br /> Repair/Demo Task I <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Final all Required Permits i /��/�� �i ✓��L �i ZL� �'� �� c=v✓w/ �S ; <br /> As the owner of the property or authorized agent of the property owner, I do hereby agree to comply with the <br /> abatement schedule noted above to resolve the violations cited by the Environmental Health Department. I <br /> understand that if these activities are not completed by the dates indicated, administrative fines/penalties may be <br /> imposed and additional enforcement actions may be taken, inclrtding referral to the District Attorney's Office. <br /> SIGNATURE OFPRO TY OWNER/AUTHO ED AGENT: PHONE: <br /> TITLE: DATE: <br /> (EHD USE ONLY) <br /> NOTICE AND ORDER TO ABATE DATE: (] ^ I� PR#: O �� <br /> APPROVED BY: , ,, DATE: ry <br /> mo:�n ' /ZL1 t <br /> END 1300 XXXX 9-2018 <br />