Laserfiche WebLink
Dec 09 09 12: 20p Kra- & Associates 55934r CIO P. 1 <br /> ���L�D A ' ' IN COUNTY EH5 LOG NUMBER <br /> AU MENTAL HEALTH DEPARTMENT <br /> DEC 0 9 2009 600 East Main's eet, Stockton, CA 95202-3029 <br /> Tele hone: (209) 468-342,a. , (209)464-0138 Web: Www.sjgov.or/4 X1 <br /> ENVIRONMENT HEALTH <br /> PERMITSERVICES PUBLIC R COR ;EASE APPLICATION <br /> APPLICANT: )Q2jQ0INCn,_ - <br /> BUSINESSIAGENCY: SOG <br /> ADDRESS: iD P1 LbrP, 1�-V;; I to/Zip C_L'0'J Is , CA 9,:;Af� <br /> PHONE(1): 3 Ll "e- PHONE(2): FACSIMILE: <br /> S5 1 -3; <br /> TENTATIVE*APPOINTMENT DATE: M Time: <br /> (Please allow 10 business days from date of applic4tion submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$�P5 Fp(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: E] List El Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street <br /> Name City <br /> Unit I <br /> 2. <br /> 7Unit 2 <br /> 3. <br /> 4. 9it9 /7n�l 3 <br /> 5. <br /> 6. nit 4 <br /> 7. <br /> 8. F <br /> ,fk 1:1 Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested; From <br /> to <br /> ENVIRONMENTAL HEALTH ZPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT WSOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) In F000 FACILITY WWASTE TIRE <br /> ;TUNDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL 0 DAIRY <br /> )KHAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 1Z WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 10 PUMPER TRUCK/YARD/CHEM TOILETS <br /> E3 TATTOO/BODY PIERCING 0 POOL/SPA 13 LAND USE APPLICATION SITES <br /> *%MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with rile addresses,contact the EHD. Applications received after <br /> 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 approximately ten (10) <br /> days after receipt Of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-U6 0/04105 <br /> PUBLIC RECORDS RELEASE APP FORNI <br />