Laserfiche WebLink
QA1`4 JUAQUIN VOUNTY <br /> NOV 02 2011 ORONMENTAL HEALTH DEPARTM&T Q <br /> 600 East Main St. Stockton, CA 95202-302 1 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: edsi Lvt ,1 BUSINESS/AGENCY: <br /> �uH <br /> d11� <br /> ADDRESS; �`l t yytw.--=; eYt�� <br /> - (� CITY/STATEIZIP: Z <br /> PHONE(1): . o _ PHONE(2): ) 77(- W4_ FACSIMILE- Cltl1 Ito <br /> - ob43 <br /> TEN ATI E'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal••Terawwo only 7must be confirmed) <br /> ❑CHECK BOX To EXPEDITE REQU T 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 LIUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE—(a�t/fr <br /> Electronic Information: ❑ Llst❑ Map-Description: ------ <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1, 1630Unitl <br /> A ve,Lut F 5}o�le�eh <br /> 2. lbz <br /> 3• ZSoI _ Unite <br /> 4. 1S2f3 <br /> 5. _.•. units )1! <br /> 6. Ifl <br /> 7. .'... Unit4 <br /> — <br /> 9. <br /> Specific Data Range of Information Requested; From Unit 8 <br /> A4L to <br /> ,�/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L�+f UYDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> L�'O1 ER CLEANUP SITE(NON-LOP) R16 <br /> UG WASTE FACILDYIVENICLE <br /> L"I'[J ERGROUND TANK(MONRORINGIREMOVAL ❑DOG KENNEL FACILITY LTwq$TE TIRE <br /> DOG KENNEL IL-7t�t/!"Y <br /> pD OUSPER WASTE GENERATOR ❑CHICKEN RANCH <br /> TIERED PERMITTED FACILITY A TEWATER TREATMENT PLANT <br /> ❑M EL/HOTEL =PER TRUCKNARDICHEMICAL TOILETS <br /> ❑-I TATT00I800V PIERCING �IJSPA ffrND USE APPLICATION SITES <br /> I-I&DICAL WASTE FACILITY 01 ER(PLEASE SPECIFY) An � /� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvirw: MONDAY- t8:00 A p erEXCLU nttwmx r9ytr.[Yrt. <br /> FRIDAY 8:00 AM-5:0&M(EXCLUDING HOLIDAYS) <br /> 1. List un to tenaddresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. F x <br /> ranges will not be accepted-for additional asslsto a with file dress s,contact t e EHIYs_Ill,441Sat onsabove. <br /> lved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(to) <br /> days after receipt of application. The files will be held for a maximum of Rve bualness day&for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> sae use oKLv <br /> eNo/s-0e <br /> OrashO <br /> L00/Loot <br /> XVj EuLO LLOZ/ZO/LL <br />