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SAN JUIN COUNTYPUBI-IC HEALTH SiCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST VVE13ER AVENdE,THIRD FLOOR <br /> JUL 0 3 2000 / <br /> S7OCKTON CA 957-02 <br /> (209) 465-3420 <br /> ENVIRONMENT HEALTH <br /> PERMITISEWCES PUBLIC RECORDS RELEASE APPLICA ON <br /> t P Vt M n n2mv- <br /> APPLICAhT "�� �-'J--.------�USiFiESSIAGF..NCY � � <br /> Aon s$ 3 5 (t, �,� <br /> PRONE `-' 3 L- �ACS[�rtILE <br /> TENTATIVE*A.PPO[N7MENTIME <br /> T DATE licatjcn submitla!} <br /> [pleat¢flsyo 7 to 14 business days from date of app <br /> CHECK BOX TO EXPCDITE REQUIE,$T-578.00 FEE-REQUEST FROCESSED IN y BUSINESS DAYS�1 y em <br /> L+�7 E ��.. <br /> �1GNATURE OF APPLICANT <br /> -� FILE ADflRESS PHIS SIDE 5KD STAFF USE ONLY <br /> PROGRAM ELPMENTS S>IF <br /> Al2CH <br /> 5 Z-(' 16 r7 <br /> S C$ Lo' cl t4r-tePN c.',cro^ :-) <br /> t Inca In ST. 6 CVc10A S_ <br /> 5Z `1-3511 ZZz� Zu <br /> t-T to 5T. <br /> Lr If WA <br /> 2341 35z�O <br /> 5 15 W� Gkar try I.J <br /> Lavu[. o d i <br /> afl N r Coaly 5 t�T <br /> ENVIRONMeNTAL.HEALTH DIVISION FILES <br /> ❑ HOUSING A15ATEM1=KT 0 SOLID WASTE FACILITY <br /> .�l UNDERGIxOUND TANK(UST)CLEANUP SITE(LOP) p FOOD FACILITY ❑ SOLID WASTEvEHICLE <br /> 0 OTHER CLQ NUF SITE(NON-LOP) O DOC,KENNEL n DAIRY <br /> C UNDERGPOUNO TANK;MONITORINGlREMCYAL} in CHICKEN RANCH 0 PKG TREATEM$M PLAKr <br /> C1 HAZARDOUS WASTE GENERATOR C3 MOTFUhtUTEL ❑ PUMFLRTKUCIUYARDjCHEM TOILETS <br /> ❑ TIERED PERMMEO FACILITY ROOUSPA 0 LAND USE AP?LicATION SITES <br /> ElTATT00fSODY PEIRCING 0 PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ 1AEDIGAI.WASTE FACILITY <br /> t, List up to ten addresses in the space above. Select the types) of files from the ItSt above by checking <br /> t one file type MUST be selected. Fax to {209) 464-013j or mail to the <br /> tile appropriate boxes}. At leas <br /> address indicated at?oVe. <br /> 2. EHD wilt notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitter when the file is available. <br /> A. any file not rotUM&Ld in the same condition 3S released will be reorganized by EHD Staff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be,processed the n$Xt business day. . <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I INITIALS <br /> dIATE CONFIRPHONE ONE FAX <br /> REVIEW DATE <br /> TOTAL P.01 <br />