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NIYI' tiY 0-r0-00 :e , .7 .,,. - --- <br /> - <br /> _ Postit"Fax Note 7671 Onre,} r 0 <br /> pu Vm <br /> i <br /> i <br /> 99- 122 <br /> SANJ AQUIN `ws'L"l <br /> PUBLIC EALTH SBRVIC"RS <br /> R IROt AL EiEALTIT I)MgIOa n <br /> PUBLIC MC _D3 RELEASE APPLICATION <br /> APPLzcm T PHOVE rm �`7 <br /> ADDR sSS <br /> AGENCY NAMB PHONE NO <br /> ADDRESS j <br /> *f�*iir�rtklE7F't4til,r#i•tt*#•#*.•t***#*t' xx#4#kit+*#t•tilr7t*•R4#t##**-k•kkt##trt•***## I <br /> MMLI. ADDRESS kivbITS PRQG0P, <br /> C tb7 <br /> *� saw 1`7 i► # <br /> Ott vw <br /> t♦rttA'Irtlr�r�,rxitt�tt,t,t•t#t+##1M,�.#,t�•+�+#,t+###,►,t,t+r,p,r*t,rxxtr,etittt:rx,t,ttt-t,�.rx . <br /> THIS NOTICE 1S.SUR.IECr TO THE REQUIREMENTSI IDENTIFIED.IN THE PUBUC HEALTH <br /> SERiITCES/ENVIRONMENTAL HEAL-m DIVISi N (EHD) POLICY #94-007, ORDINANCE CODE OF <br /> SARI JOAQUIN COUNTY. EHD FEE AND'SERIACE CHARGE RESOLLMONS, STATE WATER CODE, <br /> GOVERNMENT CODE AmD THE EveDENCE C DE. <br /> r <br /> 1. A MAJOMUM.OF TEX LIM PREMI$E Am ESSES PER REQUEST <br /> 2. PUSUC FILESMECORDS RE`/tEW IS'8y IfffUENT ONLY, APPOINTMENTS ARE PROCESS- <br /> ED gY CAU.ING (209WA-3420. OFFICE NO(RS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLubtNG HOLIDAYS, 8.00 M TQ IZ-00 NOON AND 1:00 TO 4_30 PM. <br /> 3.. A PUBLIC FR-ES/RECORDS R.ELEASE APP CATION (PRRA) IS RLQIARM. <br /> 4. PUBLIC FILESJRECOADS NOT RETURNED V THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHO STAFF AT THE EM ENSF OF THE APPLICANT. THIS AD0177ONAL <br /> SERVICE WILL Be.B'uED TO THE APrLICAM FOR PAYMENT. (SEE END POLICY 94- 007) <br /> 9 <br /> 5. GRIGINAL PUBLIC FL.ESMECORDS SHALL NOT BE REMOVED FROM THE c'HD PRE1-11SES. <br /> . •ri J♦a.i�i�����•i♦ia.�•rr�.� ♦i��♦ �.•��4•t�••♦1 itr•+�.•♦►.•?R1+��. f••.�.♦14 <br /> SIGNATURE OF APPLICANT_^ <br /> SIGNATURE OF AELEASNG OFFICIAL DATE } <br /> EH 00 74 IREV. 9/96) <br /> _. <br /> - MAY 1 ,3 <br /> `' Tjr]TF4_ P.CC <br /> �1Viit7•.JI' �1rIt=;V ir,!_ t-Ti _ 1 <br /> PFFINIfT <br />