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1QJ UUL/UIJl <br /> _ -�, �....v aV•t. atala f.VV VY VVLI <br /> DATIr RECEIVEQ . �„�.��t•�,., ., <br /> lTl]�CENED SAENVIR. SANJOAQUIN COUNTY <br /> IYIENTAL H.EALTij)DEI'ART1Y ENT <br /> 304 E Weber'Ave 3"Floor Stockton, CA 95205 <br /> JUL — 6 200209) 46$-3420'Fax: (209)464-0138 Web:www,co.sau joaquin.ca.us/ehd <br /> ENViRONMENT HEALTK <br /> PERMfT/SERV G PUBLIC RECO�tUS LASE A.11P-�PLZCA7CZQN <br /> APPUCAKr:.. � >�. J�uSi,fj BUSINESS/AGENCY: <br /> ADDRESS: `�.� �t �ff(i� <br /> PHONE:f[��i� i�-+rf— 13N FACSIMILE: Cam)qN$ _aC�a 1 <br /> TENTATIVE*APPOINTMENT PATE: `J'/,-za Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDrrE REQUEST-S33.00 FEE–REC2UEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l F DATE <br /> Department Use only <br /> FILE ADQRESS UNfr <br /> 1. ski it o o c�► ❑ Unit 1 �t <br /> z. acs TZ040 Oty Zorij eA, <br /> 9. $ �o� 6 AP.—Unit,2 <br /> A. C. tzit �a7 tsa �1 k <br /> s. sues+ citf I gA nit 3 <br /> 6. SUcet <br /> T. <br /> sueel a /Unit 4 <br /> a sCRY Unit 5 <br /> 10. Street G <br /> 'ENVIRONMENTAL.HEALTH DEPARTMENT FiLES 4 <br /> UNDERGROUND YANK(UST) _LjE, ii1P Sn-p(LOP) ❑ HOUSING ABATEMENT Bi SQL1D WASTE FACILITY <br /> OTHER CLEANUP SFM(NON-LOP) ❑ FOOD FACILrIY U soLID WASTE VEHICLE <br /> 19• UNDERGROUND TANK(MONITORING1REMOVAL) ❑ DOG KENNEL, El-DAIRY <br /> 0 HAZAFDQUS WASTE GENERATOR ❑ CHICKEN RANCH 0..PKG TREATMENT PLANT <br /> ❑ 'n5RED PERNIF1 ED FA,CiLrry ❑ MOTEU14OTEL Cl PUM,,PER TRUCK/YARDICHEM TOILETS <br /> ❑ TATfOGIBODY PIERCING 0 POOLJSPA QL LAND USE APPUCAT10N SHES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to LH91 464-0138 or mail to the <br /> address indicated above_ <br /> 2, EH4 will notify the applicant if any EHD flies 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 submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the;appiicant, Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5. '"TENTATIVE appointment dates must be confirmed with EHD Staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> QNiIRMD'APP011ITlull=N i-9jAT>_' ^AIME <br /> - it ;, i. ._• ,.;5 <br /> DATE GQNFIF:1liED PHONE FAX 1N[TIALSI. - <br /> REV1E-WED YES NO REVIEW DATE. <br /> FHEI.8-02-006 ' <br />