Laserfiche WebLink
""A I D <br /> SAN J U A Q U I N Environmental Health Department <br /> C O U N T Y PUBLIC RECORDS RELEASE APPLICATION <br /> EPd'dlR 0PdAr,'�1+E.iA 4 tf ffkLT H � l <br /> PEIWfT/SERnT BY EMAfL <br /> EHD LOG NUMBER. <br /> APPLICANT: h6Q o� ,�rn�f 11 t/ `-'i n r�2-BUSINESS/AGENCY: �(s 6 A S s-(A'l��i N <br /> ADDRESS: Elrclnll_IN�5 Pzy �- CITY/STATE/ZIP: <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be ailable. <br /> Staff will contact ou_to arrange an app ent date and time to review the requested records. v <br /> SIGNATURE OF APPLICANT Ci[t1�- �Cp�// DATE 4/1 G <br /> 1. List up to ten addresses in the space be ow. Add s ranges WILL NOT be accepted. Select the type(s)of files'from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(dsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> 3. 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 /> 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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ ListZ,Map—Description: ,? I uT- <br /> Specific Date Range of Information Requested: From Q .i CU to G j <br /> ENVIRONMENTAL FILE ADDRESS i <br /> HEALTH DEPARTMENT ponly, 9 p G <br /> FILES S ecific addresses address ranges will not be accepted) EHD USE ONLY <br /> ❑l ZWgQ&%ITKkMM Street# Street Name city <br /> 2y2D W hr6tnr )zC ❑ <br /> h s6df�fi ❑EMW <br /> ❑Tie�if�IrtiiedFiffaYy 2 <br /> ❑/lbs Qu&Twk <br /> tf��/Remo ❑P&% <br /> 141211111ldmilf�is 3 <br /> ❑ / r� <br /> ❑�iialil�faF�r/iier�"� ❑iAi�tQxttfl <br /> ❑Fbad F� 4 <br /> ❑Fad/4m ❑� <br /> ❑DiY a <br /> ❑ <br /> LadUmApladmBlEs Hum <br /> 6 <br /> YINI/G.Rmaei Talfills <br /> ❑WMwArTmosst Pat ❑CL% <br /> ❑m3ailivAhmma 7 AWIkNVIrW <br /> ❑�ld'B1�ii 1/��1� ❑Q1% <br /> ❑MadW io Ficillily <br /> ❑T RSV ❑�ifo1N� <br /> ❑W&Tn e <br /> M���1�( <br /> —BOXED AREA-EHD USE ONLY— <br /> Records provided by Staff-PPR Complete. staff Name: EHD 48-N <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.corn <br />