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1a ,� ♦ ApFacamens Was M t•Mh«\ /WwN1W Prove"CoNpH(.l w ICW* TO 449M AgYcNlw� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT GENERAL <br /> �'Oa"a"'"MpO11 APPLICATION IF VEHICLE INVOLVED,atVE <br /> coAmMrR�oR uanroR ENVIRONMENTAL HEALTH PERMIT/SERVICES Make ------ <br /> DID*"AlRLOR LIC. No. <br /> LNCXNN pdoeom IM MAK"mitsurm aelNras <br /> "0111IIAAnFeel1C to"WATu"MPU" Reglel. No. <br /> FAAAISER 394241 SEAL ESTAn NMPSC11ME Color <br /> r$KTRV M11CMU M KDWUZ <br /> M$CUTAMOM WEICU <br /> r ca <br /> Applltlon Dale December 16, 19�ushaaa/Name To Appear On Permit Jerru Jou & Aasoria1-ac <br /> I.Type Pwmlt/Somice Requested: Underground - <br /> Applicant Nanw, Jerry Joy & Associates Address 7000 U Uninn ct"eet, <br /> _BYe1MN Telephale NO. ( EmenganCY <br /> 209)462-1481 TelephoneNo.(209) 462-7487 <br /> Prop" Location/Address 1050 N. Union St, , Stockton <br /> -{P�y Olnef Stockton Ambulance Service Address 1050 N. Union St_ <br /> 7I Opa(alO(s Name SAME Address <br /> 1. FOOD ESTAlUSHMENTS Total Building Sq.Footage Restaurant.Maaknwn Sodkv capacity <br /> ❑ RESTAURANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT ❑ COMMISSARY ❑ ICE RANT ❑ BAKERY <br /> ❑ ROADSIDE FOOD STAND. ❑ LKX)OR STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> ❑ CONFECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR <br /> ❑ VENDING MACHINES/NO.of ❑ M081LE FOOD PREP.UNIT ❑ VENDING VEHICLE <br /> ❑ FOOD CROP HARVESTING/Nm of Field Enricryees <br /> ALL APPLICANT8: Total Er(pbyees Including Operators <br /> 1 HO1111NG <br /> ❑ HOTEL/MOTEL/Nm of Unb ❑ CERTIFICATE OF OCCUPANCY <br /> ❑ MOBILE HOME PARK/Ho.of Spec« <br /> 1 WATER QUALM ❑ WATER SAMPLE(Bacterial) ❑ CHEMICAL <br /> ❑ PUBLIC WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER <br /> NO.OF PUBLIC SERVED(Conrad Pa;) <br /> t. REQIEATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE <br /> S. VECTOR CONTROL ❑ POULTRY FARM/Malcinnum No.of Bkds <br /> ❑ KE7EF/8/R(Rlw+ya /Anunel POPLA900n NO. No.of Conflnlrg Capes <br /> Sew"Disposal IA00,Fod _ <br /> Solid Waste Dtaoosel Method <br /> Witter Supply Source Anleal Waste DisPosal Meowd <br /> IL ❑ CONSULTATION FEE O 8USIF1ESS LICENSE <br /> 7. ❑ RAN CHECKING FEE ❑ DANCE PERMIT <br /> IL REAL ESTATE <br /> REOUEST: Water WellIrap.0ion❑ SMnple❑ Title Compary <br /> Sews"System Irl.pwition ❑ Address Tele.No. <br /> Escrow No. <br /> Seller Seller Addnas <br /> Telephone No, Seller Agent Name <br /> S Fn a Requasl For Dale <br /> I hereby Cerilly that I here pneparsd this appllesllon and that the work wilt W done In accordance wit Joaquin County <br /> ordinances.Stale loose.and ru and repWalions the San Joaquin Local 04lrkt. <br /> APPLICANTS SI URE X <br /> Tulle LNO-S <br /> F DEPARTMENT USE ON <br /> Fee N Due:❑-AIMJALLY O"FICRoll O "A SITE 0 EAG( ❑ Jwwy I a Raaal..a By A1N+rr 31 ❑ my(a Raow.sa sr AYIr 31 <br /> I REMIT <br /> BAS( EMaIANATIp(1 slu"40 REMITTANCE 1 AMOUNTUE G DCMED <br /> PATE DATE REMITTED AMq)NT <br /> FEE <br /> LESS <br /> nus <br /> E•E NAI T V <br /> O11•(R 1 <br /> D1NeR <br /> Nr..�O'/ f4i. Nos�.p No I.r.••.I N/1 luw•rt•(LN Wn�p nr•�•�1 <br /> - Ia1R.CAN\-•I\IIAN YI(�aM\10 IWMOMYIN\LL NrAI\N�I IIMI\•\IaVIC(1 IMI6 NA11110...' IOY. ww a1o�alnw U.sla1 <br />