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CIS '1PICATK OF OCCUPANCY KOUT / FORM <br /> Permit Number:'�/408 / .3�8 Assessor' Parcel No. / 77-loo <br /> Use . of Structure : 914rc.Aou5e_ o r/G� in Woo�orcA1, q <br /> Address of Structure : 2-66-7--47 <br /> Owner: /Ice- T"M,17� Co• __Address :____ 277/ F/ey Cane Rd. <br /> Contractor: i\o�11 Co�3]� Contact Phone No. : <br /> Occ. Group: /1�'.3 ,�� Type of Construction: 11/v Zoning: <br /> Sprinklered: Yes_ Occ. I.oad :8'T / Arca Separation Wall in Lieu <br /> Square Feet:t9,5»o -f3S23 of Sprinkler:__ <br /> Before a final inspection can be made by the Building Inspection <br /> Division and prior to issuance of a Certificate of Occupancy by the <br /> Building Official, approval signatures must be obtained from each <br /> agency listed below. It is the applicant ' s responsibility to obtain <br /> all signatures and return this form to the Building Division. Please <br /> be aware that advanced notice and field inspecti time may be required <br /> by each agency prior to signature . �� <br /> Public Works Department : <br /> Approval Signature - _ Date ,3/d-00 <br /> H9NRY H . HIRATA, RECTOR, PUBLIC WORKS DEPARMENT <br /> by A] Bl.evins, ' elt] I;n(linc,er. <br /> Comments : <br /> San Joaquin Local Health District: <br /> Approval Signature_ ir� K �►^�--__ _____ Date zz-2- �? <br /> C. LELAND ,HALL, DIRECTOR <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Comments : <br /> San Joaquin County Fire Warden or City of Stockton Fire Department: <br /> Approval Signature Date <br /> STEVE THIENES <br /> COUNTY FIRE WARDEN <br /> Approval Signature Date <br /> APPLICABLE FIRE CHIEF AND FIRE DISTRICT) <br /> Comments: <br /> ( 11/85) <br />