Laserfiche WebLink
TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - • Tentative only - must be confirm <br />(\q CHECK BOX TO EXPEDITE REQU ST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSE j <br />SIGNATURE OF APPLICANT V N.Aik_ („j& MAC( DATE <br />Electronic <br />Information 0 List 0 Map - Description <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): SC0 - PHONE (2): FACSIMILE: <br />CrOZ- rA do (.0a.\( <br />1 Aa CikaK9 BUSINESS/AGENCY: Ne-.4) I 0. Prno (./1Sd <br />t.,ockt: CITY <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />1 ENVIRONMENTAL HEALTH DEPARTMENT <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />304 East Weber Avenue, 3"I Floor, Stockton, CA 95202-2708 21 ,3 53 <br />PUBLIC RECORDS RELEASE APPLICATION <br />, <br />FILE ADDRESS <br />EHD USE ONLY Street # Street Name City <br /> (9\(01:5 1Ae-A{ VOC.) csv-T5i: Unit 1 <br />LI Unit 2 <br />Orr Unit 3 <br />adeUnit 4 <br />Unit 5 <br />Unit 6 <br />tc-A-CL-A(-iCY1 <br /> <br /> <br /> <br /> <br /> <br /> <br /> NI <br />S ' 1 <br />pecific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />0 CHICKEN RANCH <br />MOTEL/HOTEL <br />POOL/SPA <br />OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM EXCLUDING HOLIDAYS. <br />List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact <br />the EHD. Applications received after 3:00 pm will be processed the next business day. <br />The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments should be scheduled accordingly. <br />A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />to <br />4NDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />THER CLEANUP SITE (NON-LOP) <br />'TIERED <br />TANK (MONITORING/REMOVAL) <br />1T4IAEZR PERMITTED FACILITY <br />RDOUS WASTE GENERATOR <br />0 TATTOO/BODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />FILES <br />0 SOLID WASTE FACILITYNEHICLE <br />0 WASTE TIRE <br />El DAIRY <br />El WASTEWATER TREATMENT PLANT <br />PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />END 48-06 <br />10/31/2006