Laserfiche WebLink
Ell UU 14 ('REV 51 SAN JOAQUIN COUNTY .� <br /> PUBLIC HEALMI< SERVICES <br /> -jgVlR0rotmTAL >:�I'+,AL"I'II DIVISION .•`:Y <br /> pUBIAC RECORDS IM,LEASE APPLICATION <br /> AYYL1CANl' �D E r <br /> PHONE,N[7ADDRESS <br /> G7 <br /> AGENCY NAME Un d- ce ONE NO 3-/ Zr"dUA-lyjei 4> <br /> ADDRES <br /> Al" <br /> 13 ADDRESS- . LYAD AGE= . <br /> s C "w.9 7 7. fg ufY <br /> 0 <br /> T141S N077CB IS Suwv_GT TO THE REQUIREMENTS IDEN-17FIED,IN' niG PUI3uC tip-ALTI-I <br /> SER V ICE&EN VIRONMENTAL HEALIN DIVISION(EHO)L POLICY#94-007, ORVINA NCE CODE OP SAN <br /> JOAQUIN COUNTY. m4u FEES AND SERVICE-CHARGE ARSOLAMONS; STATE WATER! Cotm <br /> GOVERNMENT CODE AND THE 13VIDENCH CODC.. <br /> I. A MAximum OI:vel(1I) r cmisit AvonssEs ma REQuEsT.: <br /> 2. PUBLic Fli.MRt=CORDS RBVIFsW 133y hXY_Q1N •I D y. ArPOIM74 "AR6 NtAA�a6n ST <br /> CAWNG (204)468-0340. Orma IIoIIRs rat Appott rmwts.ARF ;$CIIE0rjL6v MONOAY,"CIIitu! PAwAY + <br /> EXCLUDING HOLIDAYS, 5:00 AM-TO 17.00 NOON AND I:oo PM To 4:30 pm. .. r <br /> 3. A Puet c RscottD$RsLaAss APPMATION (PRRA)l4 ItsqulRay. <br /> +1, rusuc CIl.f VRECORDS HOT RETURNED IN nIS sAMB,CWd1]MISI AS RECEIVED wELL.88 C(3RR&CIED <br /> BY TILE HHD STAFv AT T"$ rLxmS6 OF THE APPLICANT, Twin A[}DrncNAL SERVICE WILL B6 9111 -,ITO <br /> ArrLICANT FOR PATMEMIr. (SEE ERD roucy 94-00?) <br /> S. ORIGINAL PUBLIC RI LES/RIsCORDS SHALL NOT BE RBMoVED nom THE EHD FRgAIsEs. 1 <br /> SIGNA'lURC OI= APPLICANT DATE , <br /> SIGNATURE OF R1:1.VASING OFI°ICIAL DATE <br /> No PHS/EHD RECORDS/I•ILES Aae IVSHTIFIED: <br /> r <br /> PHS/EHD R$CORtWFILEd E:Kwr oK TNs AIa1DRBSS(4)NOTED =;YUU ►v1Lb Bt;NOTIFIED WHEN <br /> RV-Co MW111J'-S ARE AYAILAN X TOIL ItF-VILW: ' <br /> n�,n enww rn Nmnc+nM DOOM - <br /> L 2 5 199! `. <br />