Laserfiche WebLink
III_ <br /> )ATE RECEIVED r END LOG NUMBER <br /> j� �� �ti���7; SAN JOAQUIN COUNTY <br /> W E�L Il 11 �� �� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> =1 5 Telephone:(249)468-3420 Fax: (209)464-0138 Web.www.sjgov.org/ehd <br /> Ef VEC!` Wr__Nl HP_ALTii PUBLIC RECORDS RELEASE APPLICA RON <br /> A it <br /> APP l i I to i`��.r.3 V�.,n I�1�Jt I� 'I <br /> APPLICANT:NT: BUSlNESS1AGENCY: <br /> I <br /> ADDRESS: �A q 13'x; t <br /> PHONE(il: �oY C7 �L �' PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMEN-r DATE: 3 ` �►� '� Time: <br /> {Please allow 10 business days from date of application submittal-•Tentative only-roust be confinned) <br /> CHECK BOX TO EXPEDITE REQUEsT-$93x00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSYNESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Z <br /> .� ^- ice— DATE -L l U <br /> �� ,I <br /> I <br /> UNIT DISTRIBUTION 0 Unit I M Unit 2 0 Unit 3 Unit4 0 Unit 5 0; Unit 9 I 0 Other(eteebronIclilstslniaps) <br /> FILE ADDRESS EHD USE ONLY <br /> stmt is street Name "? r.'0,2,M, city <br /> 2. 7,4°t TIt. <br /> 3. ' i J c.1- ':r ' 'V <br /> 4. <br /> it <br /> r IJL. L3 r I{1 <br /> 7 w. + <br /> ",i �; <br /> !� ►t. � k <br /> c <br /> } t <br /> S Lt <br /> j I <br /> r 1 i <br /> specific Date Range of Information Requested:From to� <br /> i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />' NOERGROIIND TANK ST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT I ❑SOLIDwASTE FACILITYNEHICLE <br /> mtl N <br />' ❑C�THERCLEANUP SITE(NON-LOP) C7 FOODFACRITY i o wksTE:TIRE� <br /> 0 UNDERGROUND TANK(MDNrroRINGIREMOVAL) 0 DOG KENNEL f 0 DAn IRY <br /> 0 HAZARDOUS WASTE GENERATORCHICKEN RANCH - I 0 WASTEWATER TREATMEW PLANT <br /> D TIERED PERMITTED FACILITY C1. <br /> MOTEL1HDTEL Q PUMPERTRUCKIYAROlCFiEtVI TOSLETS <br /> 0 TATTODlBODY PIERCING 0 POOLISPA I 0.LN'ND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 Ah1-5 11 OOPM - EXCLUDING HOLIDAYS. ; <br /> 1. list up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 1209 464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted–for additional assistance with file addresses,contact <br /> plications receive <br /> the EHD.Apd after 3:00 pm will be processed the ne_zt business day. f <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten t10)days after receipt of application. The files will be held'for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. �I I <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by El{D staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> �l F <br /> END 46-026 31, <br /> 1174705 <br /> �i <br /> Z'd $996-L99 60Z �{ uallV uen m9JC1 d99:V0 50 8Z qej <br />