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'l• - MprM..r.na WIN M Pr+as �VA"Q 11114,410IMIM/h+EoAp C.+w01@60<M Lwr Tt N TM AFFA.Mww <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT GENEM'�' <br /> .a.re.w.A�ldnOrl APPLIC/ATI O N �WVOLVM%a % <br /> 006111,1^471111011 Ammon ENVIRONMENTAL HEALTH PERUMSERVICE8 -- <br /> .^ortaw A14010011 Ltd.No. <br /> LK)"aft A/rDgA P.411111 teawj"Nmc TTII M.MNma <br /> NeGIST1AT10N PILIN po"MATO{tlsftllla R.plat No. <br /> Mltr*!11 am mOak TC IIIaP�cTTt>,Is Cokx <br /> POWTINT MANCON AM KINIK s <br /> raw Mt*lncaa <br /> "Y'rAppNeallon Dat. — Bus To App.w On <br /> Typo P.nTINl3. n"V.st.d: <br /> AppllcaM Nang. Addt.saall <br /> fh strums T No. -c Elewp.ncr ToWowm»No. <br /> Property Localkw aaa <br /> l oo...We Nam. <br /> 1. F000[GTABUSHM!<Mfl Total Su"mg SQ. Foot.p. R..t wvK Mattk/Iurw So-WV Cap-hy <br /> O 1161TAUnANT ❑ Fo00 MARKET RETAIL ❑ F000 MARKET WHOLESALE ❑ MEAT MARKET <br /> ❑ F000 PRocimmG PLAw ❑ Commm ARY 0W PLANT ❑ BAKERY , <br /> O ROAOSIOE F000 STANO. ❑ L1000R STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> O C 0WECTK*mAY STORE ❑ F000 SALVAGER ❑ FOOO DEMONSTRATION ❑ F000 VEMO000 <br /> D Veown MA,00NESMe,of ❑ MOMLf F000 PREP,W*T 0 VENONVG VEHICLE <br /> 13 111000 CROP 0 PAW EwVWy... <br /> ALL APPLNCAMM Totd bwPby+M Yl kk*q Op«*%m <br /> 1 "ousma <br /> O of Unb ❑c EnT*vATE OF o=ppANcY <br /> G MONLE HOME PARKMo,of Sp.oa. <br /> & WATM COMITY ❑ WATER SAMPLE(BacU041) ❑ CHEMIC'.AL <br /> O PLMJC WATER SYSTEM ❑ SMFACE WATER SUPPLY ❑ WATER HAULER <br /> NO.OF PUBLIC SERVEO(Connections) <br /> L REQ1tAmwiAL IfmTN O SMAu&MNO POOL ❑ EPA ❑ WADONG POOL O NATURAL nATNING PLACE <br /> L VECTOR CONTROL ❑ POULTRY FARMIM"knunl No.of Bkda <br /> O IAI*%M Population No. No.of Conllnlfq Cho.. <br /> Be we"Olapoaaf M*V%od <br /> Solld W"10 01aooral MdRod <br /> W~Supply dotMw AM wAA W.aM ONpmd MeMod <br /> L ❑ CONSULTATION FEE ❑ OUSINESS UCEmE <br /> T._'FLAN CHECKING ftE l[ Lr ❑ OANCE PERMIT <br /> L AM ESTATE <br /> REOUESr. Www W.N IIlap.ctlon❑ a—m-❑ Tltl.Cowtp.ny- <br /> S.Wrp.3lrAN kllp.ellon ❑ Add►w TOW No. <br /> Escrow No, <br /> soil" S.Aw AW <br /> T.laphon.No. S.A.r Apani Nam. <br /> Sam"Rapueal For 011. <br /> 1 haroby~tfY that 1 har.props d thla appllcatbn and that the work -All be done In aocordanoa with San.Joaquin County <br /> ordinances.111610 to rvlal and raqutallons of the$an.Joaquin Local Health District. <br /> APPLICAPlT S SIGNATURE X (\ Oat. <br /> F <br /> �PAIITWAfl(T�,�: <br /> f ONLY <br /> Foe Is 0%00:O•.vw>KL• O n�1w+T O rr aT <br /> 1•0w6..0 sy Ar.�tr It O!uq • Adp sr <br /> • w(ulr <br /> AASJ (K""Avoo" .ALL rO At"Itr A.CC / Au01PrT 1w( C*4f(>UD <br /> OAt( OAt( w(urttl0 <br /> "'OLP" <br /> Fitpro I^eP,;r G.7vq 1I0.00 -- - - - <br /> w10w A f.(w <br /> vpt•(MAl f <br /> w.i�....1 ti (1+.• �•.M tie r..�...tin ww.�•(VN Wry 14wroA �. <br /> 1 <br />