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Applications Will aw When mubmx�d Pnopen» Cumpo�u. a= m�nThe upp�unon. <br /> -� <br /> APPLICATION <br /> | <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES i <br /> ENGINEER'S AND/OR /F VEHICLE |mvOcvEm. GIVE i <br /> APPLICANT'S AND/OR FOOD ESTABLISHMENTS.HOUSING <br /> oowro^orox^wcxon PUBLIC POOLS,� WATEemxmpumuxomu -------------- - <br /> BROKER AND/OR REAL ESTATE INSPECTIONS Lic. wo <br /> /rrwys^wmoo POULTRY RANCHES AND KENNELS <br /> 3ro^na <br /> ow MISCELLANEOUS SERVICES noom�� wnn«� --'-------'- - - <br /> L aso --------- cu|o, -________._-_____ <br /> [Application Date 8u�noxoNameToAppear OnPermit <br /> / <br /> TvpoponninSorwoeRoquoxteu:-- <br /> Applicant wmmo_'--_Sao_uomqu Address _1810. - <br /> ou,/no,w Telephone wv� s�o,nencv Telephone <br /> �p,opo,tyLooaoon/Auu'eou'-__]��ll8--E_ <br /> Property Owner_____ *du,00x ___-__-_--_____ <br /> LOperator's Name __--_- _ Auu,ouo __-__ <br /> 1. pooD ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity <br /> [] RESTAURANT [] FOOD MARKET RETAIL [] FOOD MARKET WHOLESALE [] MEAT MARKET <br /> [] FOOD PROCESSING PLANT [] COMMISSARY ' [] ICE PLANT [] aAnsnY <br /> [] ROADSIDE FOOD STAND [] LIQUOR STORE 11 BAR [] ITINERANT RESTAURANT <br /> [] CONFECTIONARY STORE [] FOOD SALVAGER [] FOOD DEMONSTRATION [] FOOD VENDOR <br /> [] VENDING mAC*|wE8/wn. u, __-_' [] MOBILE FOOD PREP. UNIT [] VENDING VEHICLE <br /> [] FOOD CROP H*nve8T|wG(wo. of Field Employees _______---_ '____ <br /> ALLAPPL|CANTS: Total Employees Including Operators <br /> ______-__--___ <br /> � o. *Oum|wG <br /> ' [] *OrsuwOTsuwo.n,Units ________ [] CERTIFICATE upOCCUPANCY <br /> [] MOBILE HOME pARn/wo.o/Spaces <br /> o. WATER QUALITY [] WATER SAMPLE (8untunu|) [] CHEMICAL <br /> [] PUBLIC WATER SYSTEM [3SURFACE WATER SUPPLY WATER HAULER <br /> NO. opPUBLIC SERVED (Cnnneuuonu) <br /> u. RECREATIONAL HEALTH O SWIMMING POOL OSpx O WADING POOL O NATURAL BATHING PLACE <br /> 5. VECTOR CONTROL OPOULTRY FARM/Maximum No. o/ Birds <br /> __________ <br /> F :EmNEUHunwuyo ---- /Animal Population No. No. u/Confining Cages <br /> Sewage Disposal Method <br /> 800u Waste Disposal Method <br /> Water Supply Source Animal Waste Disposal Method <br /> s. [J CONSULTATION FEE <br /> r. 1:1 PLAN CHECKING FEE <br /> e. REAL ESTATE <br /> REQUEST: Water Well Inspection[] Smmp|o[J Tine Company _-__--_-__'_ - <br /> - <br /> SowuuoSvmtem Inspection [] Anumao ----___--__ 7o|o. No. <br /> Escrow No. <br /> '------_____-___- <br /> Seller_-__________-______- Seller Address <br /> Telephone mo�_-__-___-_ Seller Agent Name ___-------- <br /> Service Request For Date __-_________- <br /> / hereby vem/v that | have prepared this application and that the work will undone inaccordance with San Joaquin County <br /> u,uin*nueo. state laws. <br /> APPLICANT'S SIGNATURE X rn|a outo <br />