Laserfiche WebLink
DAT�Ihtv,6 LIT/I �j� - EHD LOG NUMBER <br /> \( (l�— i/ JU SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTn DEPARTMENT <br /> j,AM 1 0 2007 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 ENVIRONMENT HEATgjephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd7,// <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - <br /> ,' ✓c BUSINESS/AGENCY: <br /> (} <br /> ADDRESS: —1 — �_ - <br /> PHONE —0* 5PHONE(2):�Ar0-3gV-Z) FACSIMILE:A91 <br /> 11662 <br /> -77--11 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) i <br /> ❑ CHECK BOX TO EXPEDITE REQ U 110;7H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _DATE <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City — L4 ❑ Unit 1 <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4. �,;; <br /> Unit a <br /> 5 l <br /> G Unit 4 <br /> 5 2007 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> �[ ENVIRONMENTAL HEALTH DEPARTMENT FILES qq <br /> 9L UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ADATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> .7k"5{`'OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ElWASTE TIRE <br /> wf ' <br /> UNDERGROUND TANK(MONrORING/REMOVAL) ❑DOG KENNEL ❑DAIRY , <br /> P HAZARDWs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> - <br /> �TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FAGLITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - ExCLUDING HOLIDAYS. _ <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10)` <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now application may be <br /> submitted when the file is available. ', Ll <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review.. <br /> EHD USE ONLY <br />