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CERTIFICATE OF OCCUPANCY ROUTING FORM <br /> ew <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.HAZELTON AVENUE,STOCKTON,CA 96206 <br /> BUSINESS PHONE(209) 8-7123 <br /> [Address: <br /> mllt No.: Q7jQ7j�1(%p APN:Q,$(_��-09 Business License No.: e5,2 ,164- <br /> b-S to Address: 9216 -V—. ,Wrt 12. Use of Structure: \y( y <br /> ing Business As: 15Mr-HaW Planning Application No.: t',4-02- 19 T <br /> OWNER NAME AND ADDRESS CONTRACTOR NAME AND ADDRESS <br /> me: (> Name: �)Nr—p-- ([y <br /> 0 215- E ;qt— 12. Address: <br /> City: L.ODL Stab:f,': City: state: <br /> ZIP: -'�S?40 PH: 271 ZIP: PH: <br /> STRUCTURE REQUIREMENTS <br /> Occupancy G:nWaIIInL1V.u)ofSprInkI9m: <br /> { d Occupancy Load: (p <br /> Type of Const4 Square Feat: (060D_ u(LAla16 �couppm 0 <br /> Zoning: Fire Sprinklers: Yes 10 <br /> Aro&Sapamtl Yse / N� HeatedlCooled: e / No <br /> Before a final Inspection can be made by the Building Inspection Division,and prior to Issuance of a Certificate of Occupancy by the <br /> Building Official,APPROVAL SIGNATURES must be obtained from the agencies Indicated below. It is the applicant's responsibility to <br /> obtain all signatures and return this forth to the Building Division. Please be aware that advanced notice and a field Inspection time may <br /> be required by each agency prior to signature. If your project Is In a flood zone,the Building Division must have the Elevation Certificate <br /> properly signed before approval can be granted. NOTE: PLEASE BRING YOUR APPROVED BUILDING PLANS WHEN OBTAINING <br /> SIGNATURES ON THE CERTIFICATE OF OCCUPANCY ROUTING FORM, <br /> APPROVAL REQUIRED: <br /> DEPARTMENT PF PUBLIC WORKS DATE <br /> Aly— <br /> ENVIRONMENTAL HEALTH DATE <br /> AIR POLLUTION CONTROL DISTRICT DATE <br /> COUNTY FIRE WARDEN / DATE <br /> Pnfor,&Twh� AFr- ot=, Nnn/Wt�/Afwasu t Zf o,- <br /> FIRE CHIEF DATE <br /> LOCAL FIRE DISTRICT: Mbkd-`A mij6— F R K oi.ST <br /> CITY OF STOCKTON FIRE DEPARTMENT DATE <br /> CALTRANS DATE <br /> OFFICE OF EMERGENCY SERVICES DATE <br /> STOCKTON METRO AIRPORT(209)4664700 DATE <br /> NOTE TO DEPARTMENTS LISTED ABOVE: Your signature Indicates that your conditions have been met Use the reverse side of this <br /> forth to note comments or conditions,or to approve temporary occupancy. <br /> Once the required signatures are obtained,return this form to the Building Division. A final building Inspection will be scheduled at your <br /> request A final Inspection will not be made unless this completed form has been returned. <br /> 0112001 <br /> 1 \f-�' �µ r 2 F•r•/J-l� 1—I o114� n <br /> Z�I—G F1HuildngWendouu\Herdout72Aw(Revisd0628-M) _��2' E (1— 31 3 Pap Iof2 <br />