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CJ4J CJti/I tl�fi i L:i 1 71 ti:J0`i ,) - RRN�y-rry';•„ya1\Hi•rLr r - -—1 ,..,� .,,,- - <br /> j SAN JOAQCIN COUNTY �- <br /> PUBilC HEALTH SERVICES <br /> ENVIRONACMrAL HEALTO DTSION <br /> PUBLIC RECORDS RELEASE AFMCATION <br /> APPi. CANT PHONE No-.a�i&_� <br /> ADDRESS 1 C'1► .9ga9�� <br /> AGHNCY NAME lCxuza4.� -I� - - . - •--•- • • NONE NO <br /> ADDRESS <br /> FBA ADDEMS LEAD AGENCY - <br /> Y <br /> _ • _, _. oar b T ' � <br /> post-it'Fax"OtO 7871 <br /> F'om rf�� I <br /> I <br /> Tb <br /> Co. <br /> CoJOa <br /> p<tore f <br /> MUM f <br /> •1TIIS NO.IT(M tS. SURT=r To THU REQUIREMSKIS MFN7UWW IN TM PUBLIC HBhL•a'H <br /> SE RVIC&VENVWoNNfflNTAL HEALTH DIVISION(IID)POLICY M4)07.ORDiNANCB cotig OF SAN <br /> JOAQUIN COUNTY, 'TEID FM AND SERVICE CHARGE RMLU nOlg-% STAVE'WATER CODE, <br /> GOVERNMENT CODS AND TIS BVI MNM CODE. , <br /> A MAX MUM aF TUN(10)FU MISE ADDRMES PER RBQUEoT- <br /> �. MOLIC PILE =CORDS REVIEW AM BY ALTMUM= MM- APPOIN7MINTS ARE <br /> ARRANGED AY CALLING CA 9WA-0340. OFPIQ3 ROM FOR ARB SCHF•DULBD <br /> MONDAY THRU FRIDAY VWLJJDING HOUDAYS, S:OD A.M.TO MW NOON AND I*-W P.M-TO 44:30 <br /> PAL <br /> 3_ A PIJB[.IC RECO WS RE EASE APPLICATION ANDA O -,pM=M&DEPUW OF X78.00 <br /> IS aIBQURtFD. DEpOSM V4KL EA RUrM( M TO THE APPLICANT IF MW FIIJISPRECORDS ARE <br /> NOT AVAH-ABLE wrmw THE CUSMDY OF TEE Ow- <br /> 4.THS AnovE jDafr FIfiD DEPOSIT IS APPLIED To wAP"TFIL TOTAL FUM REVIEW M <br /> 4 O THE <br /> CHARGE. -ME BALANCE OF THE CHARGES ARE DUE AND PAYABLE�i 8 I' <br /> DOCUMENT(s)• <br /> 3. PUBUC jj WaCORM Nar RSJUMED IN THE SAME COMMON AS RECEXVF.D VnLL BS <br /> CORMWM HY THE SRD SrAFp AT TIM MCMSE OF UM AMICANT. THIS AM IIOfNAL <br /> 9MVICH WILL BE Bu I.TsD TO THE APPLICANT FOR.PAYMENT- <br /> 6. ORICIINAL P[muc pII,FSJIIEDS COBsum NOT EB REMOVED PROM'1A13 FAD PRDMI3BS- <br /> SIGNATURE OP APPLICANT DATE <br /> SrGNATURJ9 OF RELEASWO OFFICIAL _ DA'Z'E <br /> r <br /> BH 00 14 (R" IM <br />