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^ Fr om:MARCUS�Hy. BOLE AND ASSSTES 530+633+0119 1142005 00:43 P031 P.002 ,J <br /> REV 151J . 4640138 ENVIRN�effSA,N JOA.QM COMM AL FEALTH -^ _PAGE .'pl <br /> RNMONhtEiV7cAL HEALTH!A$PARTmzNT <br /> NOV 1 4 2005. ' " <br /> 005 30413as *ebeiAtiea 3"Ploor,StooldakC&95202-2708 <br /> oK..� 'Lone; 468-3420 Fa3s <br /> ENVIRONMENT HEALT � W46"138Web:twrwsigovc+r0eGd a <br /> v <br /> PERMIT/SERVICES 0�1p�"�LZ�pO sMLKEAPP'LICAnON <br /> APPI.fCMM 44ilA/�2nr Y7t��O /i tmN I�6tAOtrtaiw: <br /> ADDRESSr�.LQ-.—�����i <br /> i1-�k'V. • PHONE(1W1a: dd-4& PHoNE(3p9l,6 rn/ ' <br /> WV! TENTATKT Mftg�atTt= 1SOa <br /> PW*"dow w kak, days fan am a ,u6O1.•r1- mry.-,oun t een(f„gee11 <br /> Z; U O=K BOX TO E1PMn REQWEST-f/3A PFE(CASH OR CHECK ONLY(-REQUEST re0cmW IN 3 UWms DAYS <br /> IOHATURE OF APPLICANT ' DATE <br /> u"EE DrsT UBt' N a"1 O.Unitr Unn7 JFGft,4 'O Ueas UUoaa 13 00w <br /> saeata ADnOmR�F3S WD USE ONLY <br /> 1. <br /> 3. <br /> 4. <br /> t:. <br /> 7. <br /> 9 <br /> 10. <br /> `3pedfic D*O Raw of IrOmmigon PA*Mtoa:Frora to <br /> EMROHN04TAL WALTH DEPARTMENT Mm <br /> �TSf1E F <br /> M2 M <br /> O Rae MMM O WAOMTYa` • ,. <br /> •'�TArx patalQwplF♦�oYA4 0 Doe iQseai P DMY . <br /> HUSAQ0VSWA=QGWt = (3RNlal 0 WASTRYAMTREONwrPOW <br /> O Tom.®PctwnUD FOAM 0 O PU1WCkTMXXYAAarLlaxTOP EU <br /> G TAYT0003M PM=Q oPoarft O Lvmt%c Awt=mm SRls <br /> 0 Uw t`AL WAM FAmm 0 on .rArefx(R6PEta l') <br /> ' � Wu.t_Arasutc PFAIfTRECgea3 AAEAYAAAai:roAREVE-rr-MaRw,rRaoAYrbo,u�s�au -tiexuosn HauoA,s.. <br /> 1. List up to.ten addresses M fire space above. Select ft t1ke)of files from the Nat above by choWtV the <br /> appropriate box(as). At least one fie type MUST he selected. Pax to t20146"138 M MI to the address <br /> Indicated above Address ranges will not be accepted.-for addOional assistance tt18r fie addresses,eorrtaat <br /> the EHD.AppGureceived ceived anter 3..00 pm will be processed the next business day.' <br /> 2. The END will notify Me applicant N any E HO fits exist. An appointment for review will be eonflmned <br /> approximately ten(10)days after receipt of application. The foes will be held for a maxlnttatt of five bustrims <br /> days for review. Appolntrnents should be scheduled a000naingly. <br /> 3. A foe that Is acHvety being worked on by EHO staff may not be Immediately ayallable for review. A new <br /> application may be submitted when the W is available. <br /> 4. Any fde not returned in the same condition as released adll be moManked by EM staff at the expense of the <br /> applicant. Future file revievrs by ftte camp appikant may mquiiro a=93A0 deposllprtor to narAeW. <br /> v �t <br /> im"4 <br /> i <br />