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Applications Will Be Processed kyr Submitted Properly Completed. Be Sure To Sit,.,One Application. <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> AND OR IF VEHICLE INVOLVED, GIVE <br /> 5 AND, O FOOD C POOLS. <br /> WATERS.HOUSING Make <br /> OR AND, OR PUBLIC POOLS.WATER SAMPLING ---- - - - <br /> A OR REAL ESTATE INSPECTIONS Lic. No. <br /> JD OR POULTRY RANCHES AND KENNELS - <br /> ION MISCELLANEOUS SERVICES Regist. No. . _ <br /> Color <br /> In Date 13 Sept. 1988 Business/Name To Appear On PermiNorth CalConstruction <br /> nit Service Requested: Plan. Check. <br /> Name North Cal Construction Address P. 0., Box 588, Stockton, CA. 95201 <br /> _. Business Telephone No. 465-5886 Emergency Telephone No. <br /> _ocatlon/Address DeRollo Mazda, E. Miner & N. grar�__Stockton_,- CA. <br /> Owner De Rollo Mazda Address P. 0. Box 100308, Stockton, CA. 95219 <br /> - — — - - <br /> s Name _. Address <br /> ESTABLISHMENTS Total Building Sq. Footage Restaurant, Maximum Seating Capacity <br /> WRANT ❑ FOOD MARKET RETAIL ❑ FOOD MARKET WHOLESALE ❑ MEAT MARKET <br /> PROCESSING PLANT ❑ COMMISSARY ❑ ICE PLANT ❑ BAKERY <br /> SIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR ❑ ITINERANT RESTAURANT <br /> ECTIONARY STORE ❑ FOOD SALVAGER ❑ FOOD DEMONSTRATION ❑ FOOD VENDOR <br /> NG MACHINES/No. of ❑ MOBILE FOOD PREP. UNIT ❑ VENDING VEHICLE <br /> CROP HARVESTING/No. of Field Employees <br /> JCANTS. Total Employees Including Operators - <br /> ANG <br /> _MOTELNo. of Units __- _ ❑ CERTIFICATE OF OCCUPANCY <br /> _E HOME PARK/No. of Spaces <br /> -.R QUALITY ❑ WATER SAMPLE (Bacterial) ❑ CHEMICAL <br /> C WATER SYSTEM ❑ SURFACE WATER SUPPLY ❑ WATER HAULER <br /> UBLIC SERVED (Connections) <br /> 'EATIONAL HEALTH ❑ SWIMMING POOL ❑ SPA ❑ WADING POOL ❑ NATURAL BATHING PLACE <br /> OR CONTROL ❑ POULTRY FARM/Maximum No. of Birds <br /> EL/Runways ---_.-_.___ /Animal Population No. _ _ No. of Confining Cages <br /> 7,sposal Method <br /> >te Disposal Method _. <br /> oply Source _- —_ Animal Waste Disposal Method <br /> )NSULTATION FEE _._Consultation, -W@S-T-E. Miner &. N. Grant <br /> AN CHECKING FEE _ <br /> ESTATE <br /> 7 Water Well Inspection Sample❑ Title Company <br /> Sewage System Inspection ❑ Address _ Tele. No. <br /> Escrow No. <br /> Seller Seller Address _ <br /> Telephone No. __.._ Seller Agent Name <br /> Service Request For Date <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, andrulesand regulatiorls of the/San Joaquin Local Health District. <br /> NTS SIGNATURE X _.—/7 /"!�� �� -ms's/-� ' Title Estimator _ Date 10 Aug. 1988 <br /> FOR DEPARTMENT USE ONLY <br /> Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 A Received By January 31 ❑ July 1 &Received By July 31 <br /> BILLING REMITTANCE $ REMIT <br /> BASE EXPLANATION AMOUNT DUE CHECKED <br /> DATE DATE REMITTED <br /> AMOUNT <br /> AA <br /> RATION I <br /> S <br /> f <br /> aLTv <br /> IER I <br /> IER <br /> y�-FF <br /> rime Rece1tNn Parton N. <br /> P 4 Mall�tl f101i.aMtl I <br />