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'HEALTHS ERVICE-4S <br /> PUBLIC <br /> SAN t o UIN CUU I <br /> 1�.NY11i1.3N1'v11�.N'I'AL 11KAIJII i)IVISIUN ' <br /> A 'line Ilenldf officer <br /> 1�:rttrsl 111. i�tl,�itrilllif, hi.U•, h1.11.111.9 <br /> d•l� N. Snu .toagltiu SItc4:! • 1'. i). Ilax JIIA • S acktan, CA 95101-03118 <br /> 1119140-3410 =� 315 /U . eA,4 i�• S f� - �oC�7��i-c. <br /> IrUII 1'I '� 4 91 I ' <br /> Ui?NI?ItAL lN9•l1tUt:!'IUNS: � � will be <br /> .,/ intatnlntltln iu tttplicale. Allowul all quart lnl+s leavin no blanks. One w y ' <br /> �V 1• ;iat»all all <br /> vV tcltnncd la lite Rplificani Willi colu111CI ti. <br /> (110118, <br /> �. 1nr.11u10 a dctaiied elle "tap lin a srlrnlnle sltnci 11t l�ltllc tell;tulle Inn ai�bylM"piiltlaftks,k!achileld3.Well" <br /> r ti 1111 letlles (Intel[' tnwnld the hall(if Imp), sewer and Sfeifin 961#410, <br /> aliccls,adjne..t i I <br /> wcti�, ilnlltlin�ts, utlrlt 1R+tinntl pnillic utility lines (Including healer, salts 89 <br /> and d1,0011ce! 111 111}11"p fllinl h++tk 1t1 Iiis11ee1sirRvul�1 iiC4Ce ulaClCd Prioond or 10 C ca atio llacti!les. site <br /> "hall, you u111s1 sonic in wtitl11�, ilial USA Dig <br /> I� 1, t'1iut111c c pn1;a "Alglgcnfian tar llndrrproun4! <br /> l� ,1, [:nsnlllclr. 11nGn 9, "Jlalltu,isallan la itelcl+ae Jlnnlylicn 1)aln". s lull+t must be signer and dated <br /> 1►y the <br /> S, S111,11111lIle npp14)plinle fcct nail cunlplcle Page 11,111e Underlgrouud'1'n11k 1'rng+�mtt�Ee Vl►orkslleet". <br /> I LIZ <br /> Health Vivislon <br /> l.'1►lrilllcte Ili +iuc511ons lin llage Ill, lite '''F ilHi�t 1i+It!!rtickhts civice It rd",ne�Iceptithose ovitol:lnlj a <br /> �W (i'i iq !?t ll.)) "tlndergretuttd 31ornge '1'nul4 1 <br /> sljiltnttlle ata) date of lank tentoval. 'lite hilkler it( III, <br /> lpejuill ln 30 days i be lite lm* rl3nniov lGo"1tt9 lholl 1 <br /> tills futon is Cetntplcled Reid fetureled it) i 1151 LItU wt <br /> 7• S111111111 ',yntr <br /> tlt n -sloe lienflil A lr 1'tun' nate+ll elf <br /> SiteS lfety Plato 1 `14P fillsAUlulldauce Document tot specHICS. <br /> '41 add#e3X al <br /> it)/ 7. <br /> frit lhls silecille jells site. Itcter <br /> ted <br /> g, if IacH11y Is Iln•nlcd autslde til Nie oily IIIInElnicnlia11 the i11 a ncorporated City l3uz11111 ll DOpat nteints, <br /> I j by iltc C'nt1t11y ut San Jtiatl+the I)ulidliiR 1] i . <br /> �.. purs+lnnl 1u the Unitulitl Httlidin� Code STD 7U ll. i <br /> y, Ilhlnln n "1A nillllg nild Vxrnrallfnl o'er+1111" 1141"1 thecity at•Tracy Building Division prior to PI-IS- <br /> 19 11) <br /> I IS- <br /> t91U ailprtivai of Iho elusnic pin". <br /> recelpt of <br /> ely <br /> j j 141. '1110 nenxi"111ut levlcW 111110 fur "ears+re nte'i4ic"Nilc 1,a4 n We"du tiltwWill fbe feq+tiredlwith IicS70tWlltour <br /> clinq►lele4l ilia". 11 giel:ls dellci+c <br /> ice Roll elle tevle%V will'llegill.lin elle i111ie Of lealllli1111111. <br /> Subinil velificatlon of the file prtlttil tnlilt the apps peinle fire district at the removal Inspeecllon. <br /> II <br /> dv !li&It11E <br /> l 71 trio (Itevised 11/1/92) i'ngc I <br /> JI bl•islan nl Soh ]arglda Cnunit 11 Mob (:*It 5ttvitts <br />