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�],:j--;�r3••-2ir�i i 7.(i)��ait'1 �iK6r� ) i� � ) i:°�+:_t�v'er is.�l i <br /> nD S,P�N JOA(MJI l COUNWPUBUC HEALTH SERVICES <br /> ENVIRONMEWAL HEALTH DIVISION <br /> - o 4 �R 8 0 01 W4 EAST wM t AVW4u>;THIRD FLOOR � Lk rt)s'racrc�rOM cn soy <br /> C {2M)46$.'Sd2o <br /> c_i `,`i'. •,,;,,;`:4 <br /> %-ALTH POBLIC RECORDS RELEASE APPUCATIOM <br /> vnCv o �w L <br /> 74 <br /> I PHONE rS' FAMMLE <br /> TENTATIVE'APPQ*TttlElfr owsE 1 I I <br /> a 9WO 7 W 10 warn data of a ►3 <br /> MUCK &=TO axvrorm 7 -Sarr.00 , as s razes ss a,� �v Oct I <br /> SIGNATURE OF al�pl.acandT oar <br /> E %a SIiiC CMei OT'APW UW CMLV <br /> I PROGFAN ELEME M SEAW4H <br /> 7,7=7470< of r l '5 <br /> 1 UL <br /> i ? <br /> r <br /> EMVUtQNN1odTAL HEALTH QtYISTM FLEE <br /> WK0UWZUN0?AUX MT)CLFIINUP WM{1CP) 0 t0W4WQN1AT9WM D SMW WAStt'i FACUff <br /> WntM C6VA.WP WE(ITO 4 AP) 0 FOOD PACKM 0 &QUD V0ABTE 1r>HXXE <br /> UND=Rtttllyd TANK 0M AQ G PW KWORM. 0 [AM <br /> HAZAAWUS wAww uANe1mTOR o Cid ft"C" 0 PKG TMAT W.XT PLAW <br /> TING rWiffim FACU 1TY , 0 SEL © PUMMM TRJGWA6IDRKM TDAM <br /> 0 TAT[OOMCW PvAlco" 0 ❑ LAIC UM APPUCATIM SIM <br /> 0 MROWA3.wAW9 FAQUA Y 0 PUB=WATM UUUM 0 oTKM rAe9M <br /> 1. Uat up to teen addrouUm In tM upw-o above. Swkct Bo typa(e)of flWo from ttm net ab&je by akeeldng <br /> the alproixiato At least am Ina 4w MUST ba aoWaod. -EjA to CM 4414•47 W or mall to The <br /> Mog4wahaL <br /> 2_ EMG+orifi 40tify the*ppl�nt if any iMO f3se 0689. An alspviktffloM Far rowlaw will be confiny Ad <br /> &PqM clrnately five baslMess.dmy.S bUt no]&tar ma,t tan(10),days atter fit Uf appliewom-The M1te <br /> w'W ba told W a maximum of five businww days for ravlow. Appok*mr a should be winduled <br /> socordingly. <br /> 3. A Wo ttaa►t In oetiv&ly boind workod an by END s?aff esay react be imnlodlatofy AvaHawo for MV14 rr. A now <br /> apptfcaUQn may be SUDM trod whoa Mea filo Is available. <br /> 4. Any fella not r*Wrmd In ttw 6aaw c. nditjon As rwleesed will bs roorpanMod by SHO otatf at am efeipEnoe <br /> of the applkoK Fe 6Am filo rvrLews b7 go sante applicant m4 y roqukv a f 47M depaaat prior to revi". <br /> 5. 01 UffATIVE appol11t iwnt dates must be owfin, wM ENU Staff. <br /> a. Appftatwno reeMVd d aftw 2,00 pm udil km pomased the nod busbm""y. <br /> CONFIRMED ApPewmaIt DATb TM69 <br /> DATE COwiRfSIi D ..�._. Ta Mr- FAX 1NITU" , <br /> REV1EYffio YES ! ND RL1/WW"Ta <br /> an io <br /> 'CONAL A,0i <br />