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Aug 25 05 04;50p Nissa p.1 <br /> r <br /> DA j�65 EVVEDD <br /> $ Eiin I oG rruiNa R <br /> T•C{,r��j �lvjE� SA�eAOAQUIN COUNTY <br /> gN-%rjROT.,mENTTAL HEALTH DEPAR'iETMETcr <br /> 2006 304 East NA'ebcr Avenue,3T4 Floor, Stockton,CA 95202-2708 <br /> 7[elephorle;(209)463-3420 Fax:(209)464-0138 Web:'w% .s go%%orglehd 3ss <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERV! 1PUBLK: RECO"S RELEASE A.PPLICA'rION <br /> 1`7G� C 1 BUSft[FSSIAGENVf: — <br /> Asanite:ss: .- <br /> G�q `f ,�%_` %_._—RiONE(7fi �FA[:siPPILE _1 rpt �Z`dL�•� 1 c;1 ;. <br /> PiiraNEz(1):�.LW:.. � <br /> TE i#TATIVE".kPPOINI F-ttI'DATr-_ <br /> (P'IeoSe allow 10 business days from dsfee or application SWMittal••TentRUM oniY-must he c0flfi ' d) <br /> M CH1EcK.Eiox To E)3'EDiTF REQIiEST- - (GASH OP ECK ONVf)-RECN1i:ST PROCE SSE D W 3 i3USiNEsS DAYS <br /> SlGNATUR,E 0F:AFP'LIE:ANT a- .� �_.. _DATE <br /> t1Mrr[iISTRFiU'Irl - [3 Unit i 'aUnit 2 C]Unit 3 M UWt 4 Cl UA1t 5 ❑ Ufflit B 13 Mer{�:ItK tro,fcAistslrtaayx�]� <br /> _ F'lt_£AD DRESS EHO i]ON <br /> Strcer v Street Nene Crh* <br /> T 2—_ 0:3. 7t c -C�S <br /> 7-1 <br /> • 10. Gi`w!�`'L.��' � t'rrn,N.{�..w.... ,rte. _., ��,->__: __ ' <br /> pcclf o Date 1;tmge of trWarl ir0on RA-7,Eested:Frovi _ to <br /> El` RRONMENTAL HEALTH DEPARTMENT "LEE; <br /> 3 L rcrRGlv7UKD�AN.,(UST),^,LF.Amf3 STM iLr?P) 0 HCOUS MG ABATEMENT E3 SOLI,WASTE FACIC!RYfYEM. LC <br /> �Cn7a_R CLLANFAc wrE(N0N4.0P) C F000 FAGXETtt 11Vf61'E TYRE <br /> tai.remERGRUt)7AWK(MoNrT0R1W1C1+orAL) 0DoGKONli . [7DAIRIf <br /> 'ZHA2:d DOUSVrASTEGeRMPTOR' 0Ci4CKENRANCH G7 W$IVEWATERTFEATWENTPLAUT <br /> ;E!F-T,EmrD Pumir.:m FArn lir Cl MoreUiioTEL []PUYFTR TR uc rVf f fCt"TcaLETS <br /> 13 TAr vWGf,or F'a armG 0,POOUSPA M LANo UsEApeuru,TioN Sn-Es <br /> 0 Ii1E11rCjL1A7ASTE:F=ILM OTHER(PLEASE SPEC10y)_ <br /> VVCLLA14D bEP1 t=PORNIVRECUD3ARE AYAIAOIJEFoftREYEEW MomAy-FlllPAYB:o11,4m-SiKk�M - F.XCi111AMHC)L1DAY3. w <br /> I. List up to taro addrennes inj the space above:. Select the type(s)of fi8es from the list eve bry checking the <br /> appronriat.?bon(es). At least 011.,file type 14UST be selected. Fax to$20.91-_0198 9EIna.El to the address <br /> indica".- above. Address ranges will not be accepted -for additional Eassrstarice with Me sidd€9esses,contact <br /> the EHO.A.ppliaatiorls aeccabwd after 3:00 pin will be processed the next business flay. <br /> -,? nie EHD wit l notIFy the i*pPr-arit if any EHD files eidst. An appointment for Ti.-view Mill ija confirmed <br /> appmximvely terl(10)dvk-s afterreceipt of application. The files will be helld fin'a maxilnum of fire businw:s <br /> days for review. Appiotntenents should be;scheduled acoordingly_ <br /> ;3. A file$flat rs actively being worked on by EHD staff`tnay not be immediately avaYrlable for review. AE new <br /> application may be submitted%iftn the file is available:. <br /> 4- .Arty file no'!returned in the::arae concWon as released vdil be reorganized by FHD staff at the expense of tite <br /> applicant. Future fife:reviE A s by the same appricant may require a$95.00 depuelt prior to review. <br /> — <br /> r>nnrl <br />