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i <br /> .� PQM CSG <br /> CERTIFICATE OF OCCUPANCY ROUTING FORM <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> ' 4 BUSINESS PHONE: (209)468-3124 <br /> BUSINESS HOURS: 8-,A.M. TO 5:00 P.M MONDAY THROUGH FRIDAY(EXCLUDING HOLIDAYS) <br /> I Permit No.: APN:22 _2-Lo -2� Contractor: <br /> Job-Site Address: ' Use of Structure: <br /> Planning Application No: <br /> OWNER NAME AND ADDRESS <br /> Name: <br /> 44u( <br /> Address: 12 � <br /> City: D State: Com• Zip: 8 Telephone:(Sjp } Q' <br /> STRUCTURE REQUIREMENTS <br /> Occupancy Group: Occupancy Load: <br /> Type of Construction: Square Feet: <br /> Zoning : Fire Sprinklers: Yes/No <br /> Before a final inspection can be made by the Building Inspection Division, and prior to issuance of a Certificate of <br /> Occupancy by the Building Official, APPROVAL SIGNATURES must be obtained from the agencies indicated below. It is <br /> the applicant's responsibility to obtain all signatures and return this form to the Community Development Department. <br /> Please be aware that advanced notice and a field inspection time may be required by each agency prior to signature. <br /> NOTE: PLEASE BRING YOUR APPROVED BUILDING PLANS WHEN OBTAINING SIGNATURES ON THE CERTIFICATE OF <br /> OCCUPANCY ROUTING FORM. <br /> APPROVAL REQUIRED: DATE: <br /> — �?/Wo y <br /> 6P4DEP �ENOF P WO S. �f�a� <br /> r© C7 C� 7 �J C� <br /> IF ENVIR NMENTAL HEALTH <br /> COUNTY FIRE WARDEN <br /> FIRE CHIEF <br /> LOCAL FIRE DISTRICT: <br /> CALTRANS <br /> El <br /> MOUNTAIN HOUSE CSD <br /> STOCKTON METRO AIRPORT(209)468-4700 <br /> OTHER <br /> OTHER <br /> NOTE TO DEPARTMENTS LISTED ABOVE: Your signature indicates that your conditions have been met and authorize <br /> the Community Development De artment to complete a final inspection. <br /> Once the required signatures above are obtained, return this form to the Community Development Department, A Final <br /> building inspection will be scheduled at your request. A final inspection will not be scheduled until this form has been <br /> completed and returned. <br /> FIBUILDINGIHANDOUTSIHANDOUT 072 C of O.doc(Revised 2125104) Page 1 of 2 <br />