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07/20/2006 22: 18 9256856768 HULTGREN-TILLIS ENG PAGE 02 <br /> Sa, "oaquin County Environmental He; Department <br /> DATE E RECORD alt;EN FORM <br /> MASTER FjjW INFORM "AFIR"'r <br /> gag <br /> Sunrun AREASXn-EUh-uw-CLhjLX <br /> fid° �i�s*� yl�r U:.s,! .�i�17 ;X Sn NIT IV <br /> CIOMPL =WFOUlOWNER FILE <br /> F-112l 1A ow X MORMA 7 7 0,V, C�XF OWNER CbwR&vnrotvfft--*Tw Elio <br /> PROPM17y NAME4mt� <br /> T <br /> � j V Pm <br /> Fbst AV <br /> PHI -"Oc, <br /> Last <br /> Si I TAX W <br /> Owner Home Addti 27 Si <br /> Lltxtvrst <br /> city lt4o/--kL STATE Zip <br /> Owner Mailing Add, <br /> Maithnig Address CI.ty 4s Ohl state <br /> ERSM! <br /> COMIC)FAMS 0 INbPADUAL 0 <br /> OTHI <br /> M FACILITY FILE ki�- cn 21 :2 t-7 <br /> 5 <br /> "MW <br /> -1 <br /> R1 ISINF-"" I FACILM RtrP rAfjzq,&"AryvvA,. <br /> Is this a NEW Business LwATmN III preWouly ril I fated by the ENWROUMmu4"MM DEPART Ml iNT? YEs 0 NoLLAN "I <br /> EAV6 6 <br /> lsthis anEKMUNGiDtLdnesst.00ATWMbut a Nrwjhymi El <br /> regulated Businei 1� <br /> No <br /> Stun Bunw%p"i <br /> CM <br /> STATE Zpr <br /> 2, g <br /> 0 <br /> WN� <br /> IVA -W1 ,11 Im <br /> I'l Address JV,0J?4ZREWrfrom Fzd!dj-AdVnnw <br /> At mt6m:or care or(quawsV <br /> Mailing Addrip-1 My <br /> STATE ZIP <br /> In <br /> ,U�`Ew I <br /> OP <br /> 11H11"PAIRTY 131LUNg IN1,01 0rnpk?e If Billing Party Is cZjx-fpxt ham Property Owner a WFadfleratOr een5Wa4)l <br /> avoicss NAME <br /> Am uWon:orCare of('24pmr"n <br /> Mailing Adi <br /> 3 1 <br /> ztp <br /> A"W46pizacc for Ill and cholirgus <br /> -I OWNER FACIL"ISU$INES 9 <br /> THill PARTY oit-Lm <br /> 4 the undelvisucilApplicant. III stal the III OP&;l orAuthl tdAgent.f this B,,,jul <br /> ZN4MES,E:vF0W2"fZNTt"04AGjEy Radler XacwyC)mRGEv2-,,0d2ted With thlopermilan will be bored to cleatthc addrmidcotififaabove ,and I ilicknowlil that all PEll Fms� <br /> ill be P"forftcd in Alin -th0Aa4LZ[aD==for this site 10.0c"ti <br /> loformntinn provided on this aDdlc�4-a Is true and eotxxr•■-d that au ncctsb,ted <br /> --dards;2"d STATE and/or MERAL Ljll and Repl.1tiong. w pplil SAN jol CbVrqTy Ordinance Codes and/or <br /> I operator,or Rgent afox Pr*PcKtyI0`l at the above fAcillitylsitc address,I hereby authorise e 0 <br /> y And al ii And"I'virOWnfilt"ll XRS,�Uaxcuc lnfjrmat�on td RAN JOAQUIN COUNTY VNVIRONNIEWAL HFAll DE.-AR rixt th ill r <br /> -vided to All or my represtintAti Tli soon as It Is available sad at the same gral it k <br /> ILPPLICANTNAMI! y E75E Pl SZcj"Tjjji P <br /> 71nE <br /> 4 0,lot 13RIVEP-Stlt <br /> (MorocapyR910=IiEl D 983 2S' <br /> Wptvvod Fry Date <br /> AocKkmtfno W*OB procq�sll()Ample"VY <br />