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Vl,, <br /> SOAo IJ COUNTY <br /> PUB ..A. SERVICES' <br /> PLT.BRECORDS�IiEALTI3 bMSION <br /> RELEASE APPLICATION <br /> AGDPIgcy R/�MS+d�s ath S a_ f z��\< . p�oris <br /> ADDRESS T'FIOr18IVO <br /> IILB D Rce ' <br /> —_ _IzNCY —DAYS <br /> w..v.�- <br /> 16 — \——m-5j,� <br /> $E <br /> PUBLIC HEAJgAq4w.CLTH <br /> SERVITHIS NOTICE I5 ONMSUBIBCT TO THE REQUIREMENTS IDENTiFIEp IN THE PUBLIC HEpITH <br /> lOAQUIN COUNTY, BHD PEES SION ` <br /> OAQUIIBS/ENVIRENTALHEALTH DIVISION(ESD)POLICY#92.007 ORDINANCE CODE OF SAN f <br /> AND SERVICE CIIARGB RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE.AND TIB EVIDENCE CODE. <br /> I A MA7OMUM OF TBN (10) PREMISE ADDRESSES PER REQUEST'. — <br /> 2• PUBLIC FILES/RECORDS REVIEW ARE By <br /> ARRANGED BY CALLING (109)468-0340. OFFTCB HOUR <br /> MONDAY THRU APPOINNIh( OINTMENTS ARE <br /> FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 11:00 NOONA D I OD P MATO LED P.M. ' <br /> C RECORDS <br /> S RF UIRED.uDEPOSTTS RELEASE APPTICATION ANDA Iprl_REFU►JDABLg DBPOSTT OF$78.00 <br /> NOT AQVATLABI E RETURNED OF <br /> TO THE APPLICANT IF TNB FTLES/RECORDS ARE <br /> aTITI1N THE CUSTODY OF THE ESD. <br /> 4. THP ABOVE IDENTIFIED DEPOSIT <br /> CHARMS. THE BALANCE IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> DOCUMENT(S).COF TUB CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING T}IE <br /> • <br /> S. PUBLIC FILES/RECORDS NOT RE TlIRNPD IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE BIID STAFF AT THE EXPENSE OF THE APPLICANT THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC PILES/RECORDS NT F NOT M <br /> REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT _ 1 � <br /> SIGNATURE OF RELEASING OFF7CIAL _ DATE y <br /> EH 00 14 (REV 11/92) DATE <br /> '1 <br /> a <br />