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11/01/2004 12:10 FAX 209 948011'1` F 13 � ), u„1..,� .v.•..., <br /> SAN J'oAQTM COUNTY <br /> MD W .L��I 1"1 LUl EN YIKONNWNTA.L WAL'ka DEPA TK'ENT <br /> 304 E Weber Ave 3 1�1ooc_Stockt <br /> on' CA 95205 <br /> NOV .. 2004 <br /> (209) 468-3420 Fax: (209)464-0138 Web;www.co i an 3oaquin.ca usle d <br /> ENVIRONMENT HEALTH <br /> j . <br /> PERMIT/SERVICES PUBLIC FECORDS ULEASE APPLICATION <br /> j <br />` APPLICANT: QUSiN1r557AGE1dGY: t <br /> ADDRESS:— <br /> PHONE: <br /> r FACSIMILE: •��� <br /> i <br /> i� 1�'i3� • <br /> TENTATIVE'APPOINTMENT DATE; I I ro Time_ <br /> O`l ' �- <br /> (Please allaw 10 businass days from date of Applira4on submittal} <br /> l� <br /> ❑ CHECK BOX TO EXPEDrM REQUEST-$93.00 FEE–REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> DAPI- l��l <br /> SIGNATURE OF APPLICANT 1 i! DeparrmentUse O WY <br /> ' J <br /> if UNIr <br /> FILE ADDRESS ' <br /> a a y ZILO'n C 1,4 j � ❑: Unit 1 <br /> rys7 a <br /> Una 2,y�f <br /> 3 <br /> Unit 3 <br /> s. sheet E� <br /> Unit 4 <br /> T. sired d <br /> e. saw s nit 5 <br /> s. stet fl <br /> 10. Sweet <br /> •EN111R0NMEN7AI-.H <br /> i<AI.TH DEPARTMENT FILES <br /> uwuERr.ROUND TANK(IUST)CLEANUP SITE(LOP) EQ HOUSING ABAI'EIUIENS ❑ SOLID WASTE VEHICLE <br /> 0 <br /> OTHER CLEANUP SITE(NOWLOP) FOOD FACILITY <br /> 4A- UNuFRGROUND TANK(M4NrTORINGIREMOYAL} DOG LCENNEL �•DAIRY <br /> Et !� <br /> Z HAZARDOUS WA5TE GENERATOR ❑ CHICKEN RAMC}{ 'I a-PKG TREATMENT PLANT <br /> D MOTF-LA40TEL E7 PUMPER IRUCKIYARUrCHEMTOILETS <br /> D TIEREd PER11AlTTEd>ACILETY a LAND USE APPLICATION srlEs <br /> - 4 TATTOOlBOD1C PTEftC1NG ❑ POOVS?F' <br /> Li MEaICAL WASTE FACILITY 0 OTHER(PLF-aSE SPECIFY} <br /> 1. mist up to ten addresses inthe space above. Select the typets)vF files from the list above 6y checking <br /> the appropriate box(es). At least one file type MUST bel''elected. Fax to 209 464-0138 or mai!to the <br /> address-indirated above. <br /> 2. EHD will notify the applicant if any EHID files exist._ An appointment for review will be confirmed <br /> approximately five business days but no later than tent (10)days after receipt a(application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. .1 <br /> 3. A file that Is actively being worked on by EHD staff may;not be immediately available for review. A neri <br /> application maybe$Ubmitted when the file is available.'' <br /> 4. Any file not retumed in the same eonditlon az released.will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5, 'TENTATIVE appointment dates must be confirmed with EK0 staff. <br /> 6. Applications received after 3.00 pm will.be processed the next business day. <br /> •_ Ff =-� .. ,•.... <br /> CONF�FM� AP t�lEN3T�ATE �� -" _ IME; '3i:� <br /> L •x S <br /> r - PRONE ,FAX'. <br /> (NlTW1 <br /> :DATE CINFIF{141EA ! _ <br /> REVIEWED ,= YES 'NO REVIEW DATE, <br /> EHD 4"2-0at dal <br /> &=0132 <br />