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Application-Moved Building Permit SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE, STOCKTON, CA. 95205 BUSINESS PHONE 468-3123 REQUEST FOR INSPECTION PHONE (209) 466-3165 (24 HOURR RE RECORDER)RDER) PERMIT NO. THIS SECTION IS TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF SITE LOCATION INFORMATION Date: (7-`j 3 Technician: Job-Site Address: LIS I E C r I �C[Af iq v APN: 2/1 - �><4 2k Cross-Street: c; 5 S 0 b1/ I City: ZIP: Precise Location: oI l� P, g y yI e «sS C Subd. History: Subdivision Name: Map: PrC (`T�, BI/Lot# FACILITY INFORMATION Water Supply Existing On-Site Well: New On-Site Well: Public: Sewage Disposal Existing Septic System: New Septic System: Public: Storm Drainage No Change: New On-Site System: Public: Driveway/Access Existing Driveway: New With Curb-Gutter: New Without Curb-Gutter: 5 . 71 d FAddress: TION OF THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR PERMITS REQUIRED TO MOVE A BUILDING. k: 1?E<0CaTC /7SV S FT ,�E,Pwlr AhInc d'nc /,9 l7i� 1o) /�lqpt&/�C J ptsQ ZyX� #n6�nOWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS /'e�ii �i��Jf�E / //�/�� Name: s e ee/7(f Address: nnt}1 f C State: C/O City: State: L/ 5 1�i ZIP: Ph:(f77r Ph:( ) Z e` - �Y'!"a� 1 CONTRACTOR INFORMATION Ph:( ) Lie. No: Company Name: Address: City: St: ZIP: MOVING CONTRACTOR Name: ,(3/ L',OZ14- �90Li/t/ LSC Address: I S3" City: des 7o St: CA) ZIP: MOVING INFORMATION Move Date: Hours: to Height: Width: Length: Weight: HCD No: Travel Route From: To: Via: Note: Routes that Include travel on State Routes or City streets must be approved by those agencies prior to Issuance of a Transportation Permit by the County. Evidence of such approvals must be attached to the application. WHO MAY APPLY 7 ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. Owner-Builder must submit the following with the application: • A property tax statement or a recorded deed • A completed and signed"Owner-Builder Verification"form • A completed"Authorization for Application"form If other than the owner applies. Contractor must submit the following with the application: • Current license numbers and a worker's compensation insurance certification (this Is not necessary if this information Is already on file with the Department) • A waiver form If the contractor is not subject to worker's compensation laws • A completed"Authorized to Sign"form if other than the contractor applies (this is not necessary If this information is already on file with the Department).