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CERTIFICATE OF OCCUPANCY ROUTING FORM <br /> �4�IFORN�? SAN JOAQUIN COUNTY COMM UNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.HAZELTON AVENUE,STOCKTON,CA 95205 <br /> BUSINESS PHONE(209)468-3123 <br /> Permit No.: I ' � s j AM:, .0 411 Business License No.: <br /> Joh-Site Address: Use of Structure: s� <br /> Doing Business As:e ) yIt+ ' ' p 1 ; r Planning Application No.: <br /> OWNER NAME AND ADDRESS CONTRACTOR NAME AND ADDRESS <br /> Name: , 11: 1°.`6 `. . *.} ;•ir.. Name:- Ja' "" € ��� <br /> Address: . `` ;l `6 f"`7 Address, •y - <br /> city: _` :rf_e ,� jh1. state: f��' �• City: � "P7 state:r" �, <br /> ZIP: r PH: ZIP: `� j A PH: ;F4 —7 <br /> c <br /> k • STRUCTURE REQUIREMENTS <br /> Occupancy Group: ,t'Ji J Occupancy Load: <br /> Type of Construction; Square Feet: <br /> T : r � <br /> Zoning: AE-40 Fire Sprinklers: Yes 1 No <br /> Area Separation Wall in Lieu of Sprinklers: Yes 1 HeatedlCooled: Yes I No <br /> b Before a final inspection can be made by the Building Inspection Division,and prior to issuance of a Certificate of Occupancy by the <br /> Building Official,APPROVAL SIGNATURES must be obtained from the agencies indicated below. It is the applicant's responsibility to <br /> f obtain all signatures and return this form to the Building Division. Please be aware that advanced notice and a field inspection time may <br /> be required by each agency prior to signature. If your project is in a flood zone,the Building Division must have the Elevation Certificate <br /> i properly signed before approval can be granted. NOTE: PLEASE BRING YOUR APPROVED BUILDING PLANS WHEN OBTAINING <br /> SIGNATURES ON THE CERTIFICATE OF OCCUPANCY ROUTING FORM. <br /> APPROVAL REQUIRED: <br /> I-Nii l <br /> DEPARTMENT OF PUBLIC WORKS DATE <br /> �E_NIRO M TAL HEALTH DATE <br /> AIR POLLUTION CONTROL DISTRICT DATE <br /> COUNTY FIRE WARDEN DATE <br /> r� <br /> FIRE CHIEF <br /> DATE <br /> LOCAL,FIRE DISTRICT:I��I�I"��'���� <br /> CITY OF STOCKTON FIRE DEPARTMENT <br /> DATE <br /> CALTRANS DATE <br /> 1 <br /> OFFICE OF EMERGENCY SERVICES DATE. <br /> 1 <br /> 1 <br /> i <br /> l STOCKTON METRO AIRPORT(209)468-4700 DATE <br /> NOTE TO DEPARTMENTS LISTED ABOVE: Your signature indicates that your conditions have been met. Use the reverse side of this <br /> form to note comments or conditions,or to approve temporary occupancy. <br /> Once the required signatures are obtained,return this form to the Building Division. A final building inspection will be scheduled at your <br /> request. A final inspection will not be made unless this completed form has been returned. <br /> 0112001 <br /> r <br /> 17;1R­1.1'- 'Iandou01-landout 72.doc(Rp 28-02) Pagel of 2 <br /> y''� t <br />