Laserfiche WebLink
tHU LULi NUM 51; <br /> SAN JOAQUIN COUNTY <br /> ENV. /NMENTAU HEALTH.OEPARIN[_ s 4 <br /> s <br /> 304 East Weber Avenue, 3rd ton, CA 95202-2708 .sq <br /> A' Telephone: (209)468-3420 Fax (209)464-013 Web:www_sjgov.org/ehd <br /> �A� �- 1005 <br /> ENVIROWENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /BUSINESS/AGENCY: �. <br /> ADDRESS: <br /> PHONE(1):arRte!-Z'�������'�� PHONE(2)�:1�����rz�f�r FACSIMI/L <br /> TENTATIVE"APPOINTMENT DATE- f%'1_iti p� _Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> r�,,l'� <br /> SIGNATURE OF APPLICANT ����: �l�l /Gg�� DATE <br /> R <br /> UNIT DISTRIBUTION O Unit 1 0 Unit 2 Cl Unit 3 nit 4 t7 Unit 5 C2 Unit 6 0 Mor(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 2. ��, �7 r-.bra <br /> 3. <br /> 4. 1. <br /> ter' __ D ' <br /> 5. G/71 <br /> LAS;v8. v <br /> - �' I"As v <br /> 10. NOW <br /> Specific Datn Range of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> Ll UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> d OTHER CLEANUP SITE(NON-LOP) <br /> FOOD FACILITY ❑WAsTE TIRE <br /> �UNDFRGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 13 MOTEL/HOTEL M PUMPER TRUCKIYARD/CHEM TOILETS <br /> CI TIERED PERMITTED FACILITY C3 LAND USE APPLICATION SITES <br /> M TATTOOIBODY PIERCING POOLISPA <br /> ❑MEDICAL WASTE FACILITY AOTHER(PLEASE SPECIFY) !i �,�- �Y r�F <br /> Ir <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAULE FOR REVIEW- MONDAY-FRIDAY 8:00 Am-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 2091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively be' -�,vorked on by EHD staff may not be immediately available for review. A new <br /> application may be sul ITh(an `"n the file is available, <br /> 4. Any file not returned ' i/per. L/1���. ' as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future fil! cyF�,Z -nt may require a$93.00 deposit prior to review. <br /> cin <br /> EFIO A9-02.006 <br /> t tl27(04 r <br /> J <br />