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SAN JGAQtJM COUNTY <br />CLIC DEALTII SERVICI <br />"N IRo NN'JENTCORDS RELEALTH DNL�ION <br />PUBLEASE APPLICATION <br />APPucANr Q r n P , PHONE NO C� 11 <br />ADDRESS 35DS rnbe wood C le #� IS J�G�3 <br />AGENCY NAME LQLo I1"n f SX 7� Ol5' i <br />ADDRESS- Ul P s e �' Znc HONE NO C 811 �{0-117 <br />FELE ADDRFSs LEAD AGENCY <br />ATE <br />7 9b0 S6o% Cherp",,n Lane <br />� o c a g5 auto <br />Les -� tnis <br />gddl`es� cow\ nD, eg f <br />q5 = fie. Dam p'I Co._ <br />Reac on <br />Set Se vice Si- -�' <br />�.4A I-TOt'n�n \1�jeC vc-oofceS IieD 1 aS 9� <br />i�11��ocn�o, Wa�ec' Reso �r�e �� ; `l as 9y <br />! <br />PAYMENT; <br />Cr-IvED <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTTIDCEZ7$L1C S TY <br />SIItVICES/ENVIRONMFN'TALHEgl iTi DMS10N (1:FID) Pi'�1�� J'+EiEALTH <br />JOAQUIN COUNTY, EHD FEES AND sfiRvrcE ANC CODE OF SAN <br />GOVERNMFNT CODE AND THE AND <br />CODE CHARGE <br />SOLUTIONS, STATE iVATER CODE. <br />1 A MAXIMUM OF TEN (10) PREWSE ADDRESSES PER REQUEST. ' <br />Z• PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTmpNT ONLY. APPO <br />ARRANGED BY CALLING (7(79)468-0340. OFFICE HOURS FOR APPOINTMENTMENTS ARE <br />P. M. S SCHEDULED <br />MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 5:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br />i <br />3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON. R r�NDABLE D <br />IS REQUIRED. WILL BE OBIT OF $79.00 <br />E FIT "FC CORDS ARE <br />NOT AVAQAE WIT US g WITHIN THE CUSTODY OF THE EHD. TO THE APPLICANT IF TH <br />4• THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL PILE REtrIEq,, FEE <br />CHARGE. THE BALANCg OF THE CHARGES ARE DUE AND PAYABL.H RIO TO VIEWING THE <br />DOCUMENT(S). R <br />5- PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RE I ED <br />WILL BE <br />CORRECTED BY THE EHD STAFF AT THE FFD TO THE APPLICANT FOR <br />OF THE APPLICANT. THIS ADDITIONAL <br />SERVICE WILL BE Brr_r ANT FOR PAYMENT. <br />6. ORIGINAL PUBLIC FILES/R& ORDS SHAL N BE ! <br />- // �1 M i1 FROM THE EHD PR-NUSFS. <br />SIGNATURE OF RELEASING OFFICIAL <br />EH 00 14 (REV 12/92) DATE <br />