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� tao <br /> X00 <br /> SAN JOAOUiN COUNTY 7N[EN7 <br /> COMMUNl7Y Dlovs- MEt+17 pEPiAA <br /> NATF,ITON AVE,6TpCKTOK CA u5M&49212 <br /> pi{QNE-10?74bi.9121 FAX1 gppl4pg'Jib9 <br /> CERT4FiRCOUTING FORMLIAt3CE <br /> Tian s can be approved by the Cornrnunity pevelopMant <br /> Before the Certificate of Comp } all signatures agencies <br /> return this form to <br /> nt APPROVAL SIGNATURES must b taro tainedfrom the agencies indicated <br /> gepar a licant's responsibility W obtain <br /> below. 1t is the app <br /> the Community Development Department. <br /> p� (conditions approval are <br /> Minor Subdivision Application Number: <br /> attached) pate: <br /> Approval Required: <br /> l7epartment of Public Works <br /> dIr enta $alth Department <br /> p Air Pollution Control District <br /> 0 County Fire Warden d <br /> ❑ Fire Chief / O <br /> Local Fire District: <br /> 0 City of <br /> 0 Caltrans <br /> Cl Office of Emergency Services <br /> 0 <br /> t er Ag Gy <br /> t. Cblrt;i <br /> NOTE TO DEPARTMENTS L1S7ED OVE:Your signature indicates that your conditions <br /> have been met. Use the area below to note additional comments or conditions. <br /> 1 <br /> i <br />