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12-28-19955 2_S5PM FROM AGE NC 209 9S6 0700 P 1 <br /> SAN,IOAQC.}'I<N COUNTY I <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> KIBLIC RECORDS RELEASE APPLICATION <br /> a��vi� T fit') <br /> APPLICANT �r► �'i {��ugNb _ art PH No <br /> ADDRESSJ'&& <br /> 4 4 A- . 5 7 <br /> AGENCY NAME PHONE NO <br /> ADY]MS <br /> ME Apl)ms LEAD AGF. CY <br /> Iry Ti.;ATF <br /> w. 05 LAlik �s E <br /> Ik.an 3� 1995 <br /> 4 <br /> 75Alpwkrt Auj ENMRO 1 !SERVICES 7H <br /> If T3i1S NOTICE 13 SUBJECT TO 771E REQUIREMENTS IDENTIFIFI) IN 771E PIII3IIC HEALTH <br /> SERVICES/ENVIRnNMENTAL HEALTH DIVISION(I111I3)POLICY#92.007. ORDINANCE CODE OF SAN <br /> 10AQUIN COUNTY, MID FEES AND SERVICE CHARGE RESOL.l1'i ONS, STATE WATER CODS, <br /> GOVERNMliNT CODE AND THIS EVIDENCE CODE. <br /> I_ A MAXIMUM OF TEN (10)PREMISH ADDRESSES PER REQUEST. <br /> 2. PUBLIC: FILEVRECORDS REVICW ARE BY APPOINTME:fYr ON1 Y. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE (TOURS POR APPOIN`I7v1ENTS Awl SCIirDU1ED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M.TO 4:30 <br /> P.M. <br /> i� 3. A PUBLIC RECORDS RELEASE APPLICATION ANDA NON-RC1 1NDA11L DEI'[)SI`i'OF$78.00 <br /> IS REQUIRED. DBPOWTS WILL, BB RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE W17MIN'lHE CUSTODY OF THE EHL]. <br /> 4. T14E ABOVE IDfibMFIE.D DEPOSIT IS APPLIED TOWARDS THE T(-^r1'AL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLEKP__IOlt TO REVIEWING Tilly <br /> DOCUMENT(S). <br /> i S• PUBLIC I:ILESIRECORDS NOT ITE'CURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAN AT IME EXPENSE OF TIME APPLICANT. THIS ADDI77ONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT_ <br /> b. ORIGINAL PUBLIC FILES/R.9CORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES_ <br /> i <br /> SIGNATURE OF APPLICANT DATE L <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> HU Oa 14(REV 12/92) <br /> f <br />