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�0/14/2004 20946B)M63 FIFTH FLOOR Ngtg d2 <br /> DATi=RI:cENEa SAN JUAQTJIN COUNTY <br /> END LOO NUMB t <br /> -._ <br /> EN IRONNMNTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3''"Floor Stockton,CA 95205 <br /> DEC 1 5 )469-3420 Fax:(209)464-0135 Web:www.co.san joagUftLca_us/ehd <br /> t ;i_- PUBLIC RECORDS PMEASE A.PNLICATION <br /> APPLr—AXT:• <br /> •,u�aE�s- � p - ( �� GI�-- �1 <br /> PHONE: 1 i l L� FACSIMILE: <br /> TENTATIVE,APPOINYMENT RATE: Z11 d rN1e; $D <br /> (Plt;ase allow 10 busim-33 d:t+s Cram Ate of application submRtal) <br /> CHECK Box TO EXPEDITE REQU i"— EST.P R 3 BU ESS DAYS /91 <br /> SIGNATURE OF APPLICANT DATE 7 <br /> Degan--n Use Only <br /> F19 ADDRESS UNIT <br /> • I1 ❑ Unit 1 <br /> L smeex CRY Unit 2 <br /> s sweet • <br /> L EwmeUnit 3 <br /> 6. street <br /> MY Unit 4 <br /> a <br /> o. My Unit 5 <br /> to. sweet a <br /> ENVIRONMENTAL HEALTH P19PARTMENT FlL.ES <br /> jd UjDERmRouwD TANK Vs-0 c.EANUP SITE(LOP) ❑ HOUSING AeAYEMENT 13 SWO WASU F .. - <br /> Q P❑OD FACKMY ❑ SOLID WASTE V <br /> 0 OTHER u.F�luP slTtc(Nota-LOP) . <br /> Or UNDERGKOUND TANK(NOWMRINGMEMOVAL) a 000 KENNE=t. C DAIRY <br /> D HATARDOUS WASTE GEOWRATOR 0 CACKEN RANCH d PKG TRE'ATMFXT PLAN' <br /> Q nE Eo PERMn1W FAC"M O MIOTEUHGIEL, 13 PUMPER TRt1CIVYAR=HEM TOILET'S <br /> O TATTo=dPY PIERmc POOL/SPA 0 LAND USE APPUCATION SITES <br /> Q MEnICALWASTE FACHM OTHER(PL11ASE SPECIFY) G <br /> 7. List up to terl addresses In the space above. Select the.types)of files from the list above by checking <br /> the appropriate box(es). At(mast one foe type MUST be selected. Fax to los 464.M38 or rnall to the <br /> address IndlcatAd above. <br /> 2 EHD vAli notify the applicant if any EHD tiles exits An appointment for review will be confirmed <br /> approximatdly five busin"—,,days but no later than ten(10)days after receipt of apprication. The files <br /> will be held for a maximum of five'business days for review. Appointments should be scheduled . <br /> atxordingiy_ <br /> S. A fie that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be 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 <br /> of the appliMnL Future file reviews by the tame applicant may require a S93.00-deposh prior to review- <br /> S. ''TENTATIVE.appaintntedt dates must be confirmed with 19HO st fE. <br /> 6. Applications received after 3:00 pm will be processed the maxt business day. <br /> IC1PN� �Q' alN1GM DATE TIME ;=.t.4.b::.•. ?"F ' <br /> c PRONE FA7C'- JM�TI �. <br /> 'I� /iE1NE[) 'YES ao RMEW DATE. .•k __ - <br /> v.. _ <br /> WWI <br /> 000 1103219 90T5TLZ658 XVa TZ:LT (Ia& VO/5T/ZT <br />