Laserfiche WebLink
—MAY. 18. 2004– 2:08PM MONTGOMERY WATSON NO. 923F-H[)'?. lum" , <br /> DATE D �7RECEIVEAN JOAQU]N COT7N�Y <br /> I n [ � O E J ENvmONMENTAL HFALTTI DE-PARTMfN'F <br /> 304 E Weber Ave 3`a Floor Stockton,CA 95205 <br /> MAY 18 ZM9)468-•3420 Fax: (209)464-0138 Web: wwW.cO.San-joaquin.ca.us/ehd <br /> -t�\'li '.sNMENj HEALTH PiTSLIC 1t2ECQ1S RELEASE W /I''LICATIO�T <br /> BUSINESSIAGENCY: /41_ <br /> APPLICANT: � l <br /> ADDRESS; v5 &V—�©� �C) <br /> PHONE; 6 Z <br /> g FACSIMILE: 11 �' V <br /> Time: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow,10 business days f(Om date of application submittal) <br /> CHECK BOX TO rXpEDITE REQUEST-$93 00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYSDATE <br /> SIGNATURE OF APPLICANT 4MOVrtm nt Use Only <br /> UNIT <br /> FILE ADDR1wSS a � <br /> ,. s t 3`-(DO �r.�rk�✓i <br /> city <br /> S�o�� o�► L ❑ Unit 1 <br /> S 5 L Unit 2 (7� <br /> a. s e S b.,c•� 1�1ti 3 ���I <br /> z. swot (-700 - Gc D <br /> Unit 5 <br /> a. streetGt <br /> 9. S et <br /> 0, street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> CLEANUP SITE(LOP) ❑ SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(UST) M FOOD FACILITY p' DAIRY <br /> 0 OTHER CLEANUP SITE(NON-LOP) Cl DOG KENNEL ❑ DAIRY <br /> TREATMENT PLANT <br /> IIS UNDERGROUND TANK GENERATOR <br /> C3CHICKEN RANCH ❑ PUMpERTRUCKIYARDICHEM TOILETS <br /> HAZ/1RDOUS WASTE GENERATOR p MOTELIHOTEL ❑ LANp USE APPUCATION SI11wS <br /> ❑ TIERED PERMITTED FACILITY p pooUSPA <br /> CI TAT-rOOIBODY PIERCING ❑ OTHER(PLEASE SPECIM <br /> ❑ MEDICAL WASTE FACILITY <br /> Select the type(s)of tiles from the list above by checking <br /> {, List up to ten addresses in the space above. UST be selected. Fax to 209 464-0158 or mail to the <br /> the appropriate box(es). At least one file type M <br /> address indicated above. EHD files exist. An appointment for review will be confirmed <br /> 2. EK will notify the applicant if any 10 days after receipt of application. The files <br /> approximately five business days but no later than ten( ) y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App available for review• Aneµ <br /> accordingly. EHD staff may not be immediately <br /> 5, A file that is actively being worked on by <br /> application may be submitted when the file is available. a azed by EHD Staff at the expense <br /> 4• Any file not returned in the same condition as releasedIntl may require be <br /> of the applicant. Future file rea$93.00 deposit prior to review <br /> views by the same app <br /> must firmed lth EHD s day.*TENTATIVE <br /> dates <br /> 6. Applications received after3:00 pm willbe processed the busines <br /> N!��� �8�`Ttti Kr r• wY � R1; .y� A`PAA j <br /> � •���..:. , , '� l,wL `?'• ^`' <br /> •,; <br /> ' •f y '' :• }t.-��i'1it: N ;p'{tl , p' °ro �:�'', a <br /> REVIEW <br /> ` <br /> EHD 43-x2.006 <br /> 6!02003 <br />