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as <br />SAN J.,. +QUIN COUNTYPUBLIi: HEALTH SER\lICl451r <br />� <br />ENVIRONMENTAL HEALTH DIVISION itJJ ; -.4.tom. E 1!" <br />i <br />304T WESER AVENUE THIRD FLOOi2 I <br />0• , <br />APPLICANT `I' cfj C 1J� BUStNE MAoGENCY <br />ADDRESS -I (A V1 \) <br />�lf <br />ICATION <br />TH <br />TENTATIVE-APPCWTMENTDATE • <br />TINE <br />EPis"se eve Tto 191 bVNrK 9s days from Fr*W of aQpBicafWp subMM gj <br />® CHECK SOX To E.YPEiDnlE REMEST - ST&GO FEE - REQUEST PROGESSE! 44 :3 SUSI?jESS DAYS <br />SIGNATURE OF APPLICANT -7` DATE �J 1LOO a' 4 O <br />E t VIRONMENTAL HEALTH DIVISION FILES tvIH 1 -4 2� <br />: NOERGROUND TANK (UST) CLEANUP SrM (LOP) O HOUSING ABATEAiWr 0 SOUL WASTE FACIiRY <br />6F_oAY 7iER CLEANUP S 1E OaON-LOP) ❑ FOOD FACILrrY 0 SOLID WA$Te VEMCL.E <br />M ERGRQUND TANK iM01aTOQMQ1tEMOVAL) O DQG KENNEL. n DAMY <br />{iA2AROWS WASTE GENERATOR O CHLCKE:H RANCH ❑ PING TRHATMENT Pt.Aw <br />❑ YIEREDPERMliTEDF=ACKjTY O 1110ELMOTEL a pUIHPERTRUCidiYARDICHF.IIiTOttLT5 <br />❑ TATTOOtBOsY PE3RCrNG O POOUSPA D LAND USE. AFPLICA-TION SITES <br />MEMAL WASTE FACEUW O PE)Bi.IC WATER SYSTEM ❑ OTWtR (PLPAS9 SPECIF=Y AGOVE) <br />i. List cap to ten addresssls in tho space above. Select the typos) of flies from the list above by ch=kjng <br />the apprrapriate box(,--';). At least ons fibs type MUST ba ssleoted. �x��{20��,�4-{3138 9r mail m tho <br />iaddre$s indiaat .-above- <br />2. <br />ye2. EHD will nQtify the applicant if any EHO files exigt_ An appOintmant for review will be confirmed <br />alaProlC:matety five business daps but no latter than ten (10) days after receipt of applicatianl The files <br />Will be held fora maximum of five business days for review. Appointments should be scheduled <br />acc"ingiy, <br />3. A fele that iS actively being worked on by EHO staff may not be IL A%"ateiy available for review. A new <br />APPlication may be submitted when the file is available. <br />4. Any file not r9tumad in the same condition AS released Witt be reorganized by EMD staff at the aVonso <br />5- <br />4f the applicant Future fila rwieW$ by the same applicant May MQuire a $78.00 deposit prior to nWkw. <br />wrENTATIVE appaintingnt dates M1.13t be corIfinned with e"D staff, . <br />6. Applicati4rl3 recemW after 3:00 pm will be pmeessed tho next bUsiness day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMEI) PHO14E FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />am ,. <br />TOTAL P.02 <br />