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Applications Will Be Processed Wn Submitted Properly Completed. Be Sure To Si <br /> � tis Application. <br /> *.� APPLICATION <br /> i AND OR <br /> ENVIRONMENTAL HEALTH PERMIT/SERVICES <br /> \ <br /> O AND DR FSTAOLISHMENTS.HOUSING IF VEHICLE INVOLVED, GIVE <br /> JDD AND DF \POOLS WATER SAMPLING Make _ <br /> OR _ESTATE INSPECTIONS <br /> LD OR .OULTRT RANCHES AND KENNELS Lic. No. ...-_- <br /> ION MISCELLANEOUS SERVICES Reglst. No.—. <br /> Color <br /> In Date 13 Sept. 1988 Business/Name To Appear On Permi - _Cal Construction <br /> , - <br /> mi Service Requested: Plan Check _ _ _ -- --�----- - - <br /> North Cal Construction <br /> Name N -- --- ____ <br /> Address P.O._Box_$8$,Stockton,CA _ 95201 <br /> Business Telephone No _465 5886 Emergency Telephone No _ <br /> Location,Address DeRollo Mazda, E. Miner & N. Grants Stockton. CA <br /> De Rollo Mazda . _ <br /> — -- _ <br /> Owner Address P- - Box 100398 Stockton CA. 95219 <br /> s Name _ _ —_—_----__,..- - <br /> Address _ - <br /> ESTABLISHMENTS <br /> 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 Cl 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 /> ;INE <br /> /MOTEL/No. 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 /> )isposal Method ---- <br /> ;te Disposal Method _ _ __ __—_ - —------ - ----- - <br /> pply Source Animal Waste Disposal Method - <br /> )NSULTATION FEE Consultation *PM E. _Miner_Rr_N, Grant - <br /> - —— <br /> AN CHECKING FEE - ----------- <br /> ESTATE — -- <br /> T. Water Well Inspection Sample❑ Title Company ` <br /> Sewage System Inspection ❑ Addres _ ----------- <br /> s <br /> ' Escrow No. ---- - -- - - Tele. No. <br /> Seller Seller Address <br /> Telephone No <br /> -.--- — 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, and males and regulations of the San Joaquin Local Health District. <br /> NTS SIGNATURE XTitle__ Aug.Esti?lator 10 AU1988 <br /> FOR DEPARTMENT USE ONLY <br /> • Is Due: ❑ ANNUALLY _ ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January t A ReceiveE G Janua 31 <br /> /� ----�. Y ry ❑ July 1 d Received By July 31 <br /> AN ON BILLING REMITTANCE $ REMIT <br /> DATE DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUPET <br /> RATION <br /> S -- _ <br /> IALTY _- --- <br /> 12 <br /> SER A <br /> / 1 <br /> c i.eE DY DaVte — ----— _ <br /> Receipt No. Permit No. -- -' --- <br /> Issuance Date MaileE --- - <br /> o, nPrT,iev LII `Opcc in <N ViPp NMFNTn r. n v PR'np (• <br /> lT trm pc Delivered <br />