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BEFORE OARD OF HOUSING APPEALS OF SAN JOAQUIN COUNTY <br /> APPEAL FORM <br /> San Joaquin County Ordinance Code Section 8-5005 <br /> PVVQnor� <br /> be valid, a written appeal must be received within thirty (30) days <br /> �Iflcation of the violations or demand for payment and the $78 fee <br /> J QV <br /> `t,co,w� must be submitted with the appeal application. <br /> `EC (SJC Ord. Code Sections 8-5102,8-5403, Board of Supervisors Fee Order B-92-1591) <br /> Date: I3 1 20\1 Premise Address: I l LAO , ��,� 1pi 5-mr_Ic�rnn '152D5 <br /> Appeal of: Cornmungi ( PCP VaL 2-eV1TP.1_iz41MC;n Phone: 209-`i5i-9L-15j FjT. Ibi <br /> (type or print Appellant(s)name(s) <br /> Mailing Address: \1�1cI C.ftjd P�\gid. Sie �, S�c1r�n C� 952nn <br /> Legal Interest in Property: R Property Owner❑ Beneficiary ❑ Lien Holder El Person in Possession ❑ Tenant <br /> Type of Relief/Appeal <br /> ❑ The findings of violations, the findings to vacate, or the findings to relocate tenants by <br /> the San Joaquin County Environmental Health Department, as documented in the <br /> Notice dated <br /> San Joaquin County Ordinance Code Section 8-5102 <br /> The Statement of Expense for San Joaquin County Environmental Health Department <br /> inspection and enforcement costs dated io fzc:�-j <br /> San Joaquin County Ordinance Code Section 8-5401 <br /> Give a brief statement, in ordinary and concise language, of that specific order, violation, or Statement <br /> of Expense protested, together with any material facts to support the claims of the appellant. <br /> k n UV iC-vion #thAo been 5Ta- aed cAue TG u(\av"t O2.I Zl old l V 10\emr <br /> Scjuaw'z�_', on j"e_ propersy *+ Uvi,,,)q in V,/j f-k <br /> (WecHeo unwmeizoon. <br /> Give a brief statement, in ordinary and concise language, of the type of relief sought and the reasons <br /> why the protested order, violation, or Statement of Expense should be reversed, modified or otherwise <br /> set aside. <br /> 0(\Clli-�- TM CNicvion WAS C0Mp\eTed we-fen ecd `vl+e Prope"i , <br /> Fled aur 1A1\ debr+s *polied (equieed pozmns To get-`fYe prDpaziy <br /> 6PKk- it) 00M . >- - Doc�uMelw <br /> Applicant's Signature: 7z Date: 13i <br /> I CERTIFY UNDER ENAL Y J TW T E FOREGOING IS TRUE AND CORRECT. <br /> Mail or Deliver to: Board of Housing Appeals of San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue <br /> Stockton, CA 95205-6232 <br /> For assistance call (209) 468-9674 <br /> Date Received:1 I Program Record: <br /> EHD 13-XX 05/10/2012 BOHA Appeal Form <br />