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1-u3 - I_rab 1 1 :.I4AH FTRn'i AGE NC 209 9S6 0700 P. I <br /> SAN J AQ[mv COUN I'Y <br /> T: PUBLIC I3EAL'IH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �IX,IC RECORDS RELEASE APPLICATION <br /> APPLICANTe F — C, 11.11PHONH NO A5 L o a b4 <br /> ADDRESS Lj[_q <br /> AGENCY NAMH PHONE NO <br /> ADDRESS <br /> FLE ADDRESS LEAD AGENCY. DALTH <br /> '�,�►�� s._�D��J:pa S�rQ�,�.._ -Dt-�—art © ��. <br /> 76n IAd %+rlol Qa d <br /> .QI n Z n� Q 4Frco1 <br /> (k5o E . glve ___ � <br /> I O-LA F I�a.,s+�;vlz� — 5� <br /> z1? c- <br /> 5-in <br /> 543") 5. Aim - - <br /> y��7 4. G1 b,AaAp sir.r.a <br /> THIS NOTICE iS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN '1142 PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTII DIVISION(FHD)POLJCY#92-007.ORDINANCE CODE OF SAN <br /> JOAQUID' ^'•^ �""'c ,.... ............: .....�.:E RESOLUTIONS. STATE WATER CODE, <br /> GOVERN <br /> 1. A 1 I L L%J J e r, + l e rn a-K- PER REQUEST. <br /> 2. 1. cdzG:)o hat S CL )1gMrhg Or1i_Y. APPOINTMENTS ARE <br /> A RRANC S FOR APPOINTMENTS ARE SCHEDULED <br /> MONDA' M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. reciU(_eat Qt tL <br /> 3. A i�e n U I n J C I A NON-R EFUNDAIII.E DEPOSIT OF$78.00 <br /> IS REQU. APPLICANT IF THE I'ILESiRECORDS ARE. <br /> NOT AVi <br /> ►"/�2 c�S-� �S <br /> 4. T 'OWARDS THE TOl-AI, GILL- REVIEW FEE <br /> CHARGE ND PAY"LE PIUO TO REVIEWING TIRE <br /> .(h <br /> 5, p a ,.k 5 (Gly <br /> l` SAME CONDITION AS RECEIVED WILL 8E <br /> CORREC IP THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPIJCA14T FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANTCw llb — DATE 3 q <br /> SIGNATURE OF RELEASING OFFICIAL. DATE <br /> L1 00 14 (REV 12/92) <br />