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11/17/2@06 14:09 9:i�-? f'- I F}� 4 ," E_]-,'(3A <br /> NOV 1 7 200 FAQ.,�AL���`�,�4 R-17 E,NT <br /> U4 East'Weber A-ntl:ae:,3rd Floor_ 5fock.cn,CA 95,2021-2708 <br /> Telepha :(209)468-34e I,)Yax: ;209,464-0138 ITwb: ,�1".f.sjgov.I I�`y�ll <br /> ENVIRONMENT HEALTH <br /> PERMITISERVICES P-UTBILAC RWGIZI)S A ¢ rr <br /> APFL;GANT: �= r"'�. - -' G b7� ✓r _ fs 7 i F 'fF+� F Y: , <br /> AXIURES1i' <br /> pHOME(1); j"�-{l <br /> '1212 <br /> TENAT,'VE*AE.,,:I 6ef�','mEvT o-ATe:. rp t" Time- <br /> 7 - <br /> {E�fre$�3 <br /> u rHEC K S X TYa 'FENTE RETRJEST-; �h N;;;'ZF.E{C: H OR CHECK.ON!-'i PFLZ§ EST I"N I OUS—IN-5S Ups, <br /> DAT E <br /> tectrari@c I (formation; i List 'cin, V21i Tii_ption � I <br /> R-E ADDRUS 7--,HD USE ONLY <br /> FI 11211'i <br /> v i �Cf✓-- - - - t5in <br /> sRecift Da%e <br /> ENVIRONMENTAL HEALTH DEPAR"I"fi.II FILES <br /> Nf]ERC�FtDU[ti�TAW(USTI CLEANWEF 1317E WVPi M KOU-'iNC.AsATFYIC=47 O'-IU We'`3TE-;n.II,Y(7fEP.ICLF <br /> )7 S10-H=R CLeANui:Sim(NO:i-LII FOOD FAciLiTY �kh�fi�7eT7r; <br /> L,6t1DC?2 'i20lJNr)'TANK(}'{{s:`:^.T,'iAit�lG�;�»i0.'F•e.! Doc KENNEL ��'CDA7.F" <br /> .H AZAi"DOLL WASTEGEWEFcG.TUf z �CHICKEN RANCH WIV,..smvt�w-r,T?c ATIII P. ,i4;4'.- <br /> )a TiEREU FERMiTT=I FACIL I r iWOTELIHL)TE <br /> TA!TC'C?(iF ODY PIERCING .�..Ft'SP SPA '94.i.ND UsE APPLICATION SITES <br /> ;-9-IMEMAL WASTE FAcmT- Q OTHER(PLEASE -- <br /> ----LWLL AND$EP77C PEEk.%`F.ECORGS AT.F FA-A1"-BLE1 FOR RVJE4W - FAQNT]AY-f=FJQAY 8,Q0 Am-SMPM - EXCLUMN01:^'.01JE Y S._ <br /> 1, Ust t,p to tern addresses E'?the space a13ove,r3W4 the type($)Of Me$fpmArp the 115t above by vh-zcWntj r:ia .PDF rc«rr:eta <br /> box(es). At Fr-asF D-e file :;Fps MUST be selgcteal.. ;fax Lo f2999 464-EII3E3.�r ntmid fcD 8�e�c�dr�_s'snd[Cateci��v� �ke4• <br /> range .roE1#nab s acre a r r ad�itiess l .1;$€ lsce vrit7 file ad se5 e€�.rbnta t �D'Ei , Ra�.�i'sc af�n *refi€"$'red;to <br /> nm:rr;:l a€e z�svf!alm,>? <br /> 2. The EPD will.notify the a0�1.r.�nt if any EiiQ fit s,isf. An appohitmenf c, v-viei-e rr li:bc ,--xif[aned apprarirr:.�te U )-n�40'r <br /> days after'rereipt of appEi6a or- The fEY °ei 4 ii,s hPlel fOr 0 marirn J WEE c f f'':o bvnear days t'Oi.re4ie�; Appai.omw4 t:; <br /> shc w'd be scheduled aec6rdingq. � <br /> 3. R fi#: Enat is --tive?y be'in vrer et [�r byF � 'ff ii7 ly not iae ifi4GtF"-S:c#Wt---F r .uallat?iv for mriew. A�:fle ;mpli,aVm ray be <br /> _;ibmMtied u han ti q flia i v,^ Oiabis: <br /> 4, Falb`31;e not rel,urned in t"i ts"Pnle GS3rAWma 3$Mu us ed will be roorF <br /> t� =:sre file reow s hyr ti?eISFme applicapt ; x;�quiire a$95.() deposit prom W revWiv. <br /> EHD USE O ilLi' <br /> t <br />