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09/29,"?008 i.l.:29 FzUK I.!'02 <br /> w✓ <br /> "E•-:.�-^::=^C �\'\:�_�J(/�)/}�7 SAIN jr =yam' T—�7�q, <br /> - -- ilr—� ENVIRONMENTAL HEALTH DEPARTMENT � <br /> SEP X006 X30`_East Weber Avenue, 3"1 Floor, Stockton,CA 95202-2708 1 <br /> Tel_nhone: (2 <br /> 2 9 i9)468-342.0 Fax:(209)464-0138 Web: '<tiwNv,Sjgov.orgleh3 l <br /> ENPERMIT, <br /> R MT,IHEALTH PUBLIC REE CORDS RELEASE APPLICATION <br /> FC:^:°. �s}>�_ Ntg4ha BUSINiES9!AGipVCY: t� 5a °G�. <br /> ADDRESS: :ru�,� Ali �in..,r55.,,'ii.E�` E,�.i&T� �, 12 i��n F :540&'�'i'L � 6..� <br /> Pi?aTi*t 6): <br /> PHONE(2): �°J 16 Ca?-715& FACSIMILE: <br /> Tf:N T AT!!VE,1 =FP0iNTF1ENT DATE: _A Tirne: <br /> ;P:,va.,.;e^=c.,,10 business days from date of application submittal-'Tentative only-must be confir ncd) <br /> k r yt f}N TO EXP PI T E REjV;55T-$93.00 FEE(C OR iIECK ONLY)-REQUEST PROCESSED W 3 Ei <br /> Sir NATURF OF 'XPP'F.i' ANT 111-2 Ze _ DATE 9/2-q Loc_ <br /> r ,-�- r — - G >✓t3nit 3 � Unft 4 �Unit 5 � Unit& -� Other(e'ectrssnteltsst.;Jmap3 i � -� <br /> tl�, Ci.�T:-EiC:<TiC1I� a iSnit� � Unit2 — m.�=. <br /> ff / <br /> 0,9 1 7A Adei(a i ti p.. ✓ -' Q' --- _. <br /> `�r y ► <br /> •+ -711 <br /> tAl <br /> F / z <br /> f• �'it t,3 (k } i ��d9L- ..._ <br /> k� r'7 i'3 i J if V........... <br /> T <br /> S 1. ! 1 V• fes^ fi i-z...m,,..E V G i Y VI 'I f <br /> speesfle Oz�tc Rine of fnformatdon Raquested:From <br /> �J <br /> ENVIRONMENTAL HEALTH [DEPART <br /> L� '..'DES:CiR^SJ?!L?T4o':.(US-)(LEANUF Sr:F-(Lf F) 0 HOUSING ASATEME SOLID WASTE FACILI I YIUEH ..LE <br /> k T iii:?C'LEt:\±UP Si`;E(NoN-I-,0p) LC3 FOOD FACILITY C`WASTE TIRE <br /> :i�DcRG:�Oti*�G TANK(ffijOR:'i:O?3h;^u1PZFXJUAL; 0 DOG KENNEL C DAIRY <br /> PP7ARCIOVS WASTE GEAiEP,ATCR 11 CHICKEN RANCH. Q WASH-WATERTREATI TENT PLANT <br /> Pc'FJA;TTEDFACILITY M MOTEL/HOTEL M PUNPr:RTRu:K(YARD.117,'E.mToi1.ETS <br /> POOLlSPA 0 LAND USE APPLiCATI3N SITES <br /> t d"tiIT DIC.AL b'}ASTE FACtL}T Y OTHER(PLEASE SPECIFY) - _ ----- <br /> WELL AND SEPTIC PEPM- IT RECORDS ARE A.yAILA@LE FOR REmEY/• MoNDAY-FRIDAY a:ao Aai-s:40PM - E,iXCI.U:3',NG HouDAYs. <br /> list.up to ti_ auddresmes 1n the space above. Select the type(s)of files from the list above by checking the <br /> a{.prt?priate bapx(es). At least one file type MUST be selected. Fax to(208)464-0138 or mali to the address <br /> indicalad abor'e. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHU.App l watiomt received after 3:00 prn will be processed the next business day. <br /> ?. e.in,� II <br />