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aa"1.y. <br /> 'o E` c° SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> OP Office: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> Request for Compliance Date Extension <br /> LOCATION: • � `�/ Z /�S- /q, <br /> G CITY: <br /> PROPERTY OWNER NAME: 2 O J aV <br /> List tasks needed to correct all violations and provide a date the task will be completed. In the comments section, provide specific <br /> information describing the task:type of unsafe condition, type of pre-permit activity(i.e. preparation of plans, asbestos survey/utility <br /> disconnect for demolition),type of permit needed i.e. local building permit, well or septic permit, State Housing and Community <br /> Development permit , etc. Use additional paper, if needed. <br /> COMPLIANCE TASK DATE COMMENTS <br /> Property/Unsafe Condition Cleanup <br /> Property/Unsafe Condition Securement <br /> Pre-Permit Activities <br /> Obtain all Required Permits o-ne <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Repair/Demo Task <br /> Final all Required Permits <br /> Owner Comments: /7 5 I J_ 7-0 a t � S t U <br /> fle fP . <br /> SIGNA75e <br /> OF PROPERTY OWNER/ UTHORIZED AGENT PHONE <br /> t - <br /> TITLE DATE <br /> (EHD USE ONLY) <br /> NOTICE AND ORDER TO ABATE DATE: PR#: <br /> APPROVED BY: DATE: <br /> EHD 13- 10/22/13 Request for Compliance Date Extension <br />