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03/22/19S9 D^o.JJ 3163611 ; FrA; ( U <br /> Si-,N v OAQUI14 COUr4Ty <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONL1TNTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANC_ PdT�_ZY1� PHOPI13 NO A/4 x • z° — <br /> nin Ar..rrr�,�rf� ,Pn�t» Si2TlE Z./0 S1TI.rl� s� - <br /> ADDRESS /44/l _ ? PHONE{ NO <br /> AGENCY NAMB - -- <br /> ADDRESS <br /> iY#####Ac#9t###t#tf#*itfft**f#,YA#it#t#kf#ir*f*#'sfy <br /> R[T<`i�NESS NAME/ /v ' GxAI� -OR <br /> FULL ADQR= 5 TYE]?,�OF FILL <br /> I♦ACIL= �G1 <br /> Ptor_I+ ` S f7,r I f70$10 <br /> j3, <br /> a �rx <br /> l.eal.eaMA�ifdZ{� Pef'uf `L <br /> I3 �b'O <br /> i <br /> ir,tieyt**###t*##t#t*t4,lrlrk*fir**tir�rlr,iriti*#*t*f-kit*#*tt*trtt-Yk1rtX#!r#+�"ttirlr**fit <br /> TS <br /> THIS NOTICE ISI O MENTAL HEALTH DIVISION ECT TO THE NS HO EPOLICY 94 07. ORDINANCE ODE OF <br /> N"FIED IN THE PUBLIC HEALTH <br /> SANJO SJEN COUNTY, <br /> ON <br /> SAN JOA(IUIN COo�ANrEHD FEE AND SERVICE O THE EVIDENCE CODE.CHARGJ:RESOLUTIONS, STATE WATER CO <br /> DE- <br /> GOVERNMENT CO <br /> 1. A MAXIMUM OF 3[iM PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APriAINTMf;�tT ONLY. APPOINTM CHE ULE PROCESS- <br /> 2. <br /> 13Y CALLING (2091468-3420.40.DAYS. 8 00 AM TOR12 APPOINTMENTS AND 1800 TO aD30 PM. . <br /> I�O(UDAY <br /> E S <br /> THRU FRIDAY EXCLUDING <br /> 0. A PUBLIC FILES/RECORDS RELEASE APPLICATION IPRRA) IS REQUIRED. <br /> 4. PUBLIC FILE$jRECORUS NOT AHE EXPENSE OF THE APPETURNED IN THE SAME UCANTA THIS h00�ONA RECEIVED WILL 8E <br /> CORRECTED By THE fiHD STA <br /> SERVICE WILL ae BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHO POLICY 94- 0071 <br /> S. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> *oL <br /> DATE "`T9`1SIGNATURE OF APPLICANT <br /> SIGNATURE OF RELEASING <br /> DATE <br /> EH 00 14 (REV 91961 <br />