Laserfiche WebLink
eta Elle fie Plaeap Wheel ftN4Naltese Pragarh Completed.Ba Duce a ro Sign The Ap;d.sl7ort <br /> APPLICATfON <br /> e�alNae>rs A�lo�oa EMOVIOMM04TAL HEALTH PERIWIT/SERVICES <br /> . 'ZONTRAcro Ammici IF VEHICLE IrrVOLVED,GIVE <br /> ..w �OkrRACT4R ANtk011 raq xfra ,aOataRa <br /> 1ROItER ANorolt PME Parti Nam umpgiras Make <br /> �"�► ANDMA Hilal Ora"mapalitigg LIC No <br /> ;TRATION .I POKM SAW140.An gums <br /> MMOULAROM 11E11lH Regtat No <br /> Color <br /> Applleatlon Oete Z SusmewNams To Appear On Permit <br /> ryas Permiusernce R estop In1101 <br /> ,1711,11 <br /> Ap Ikant Name L►t� ,�Qt}, Cn V.roil rrlen AC <br /> canc. p r <br /> 4� .. Address r <br /> 8:701111111ralepnone No Emergency Telephone No <br /> i Property LOCWiOnrAddresa r= carnzr- <br /> 1'ProoertyOwner 154 Address ^ ('+� 95iG1- tA�� <br /> Operator s Name Address. <br /> T FOOD EWTAEEILlSHU&STS To121 Building Sq Footage Restaurant.Maximum Somwq Capacity <br /> ❑ RESTAURANT CI FOOD MARKET RETAIL G FOOD MARKET WHOLESALE MEAT MARKET <br /> ❑ FOOD PROCESSING PLANT 0 COMMISSARY C3 ICE PLANT C] BAKERY <br /> 7 ROADSIDE FOOD STAND ❑ LIQUOR STORE ❑ BAR Q ITINERANT RESTAURANT <br /> ❑ CONFECTIONARY STORE C FOOD SALVAGER © FOOD DEMONSTRATION ❑ FOOD VENDOR <br /> ❑ VENDING MACHINES/No of ❑ MOBILE FOOD PREP UNIT ❑ VENDING VEHICLE <br /> 3 FOOD CROP HARVESTING No of FIa a Emptoyng <br /> ALL APPLICANTS Total Employees Inctudinq Operators <br /> 2 HOUSING <br /> `3 HOTEL/MOTEL/No of Units C] CERTIFICATE OF OCCUPANCY <br /> a MOBILE HOME PARK/No of Spam <br /> 1. WATER QUALITY 13 WATER SAMPLE(Sectorial) ❑ CHEMICAL <br /> -9 PUBLIC WATER SYSTEM 0 SURFACE WATER SUPPLY 13 WATER HAULER <br /> 10 OF PUBLIC SERVED(Connections) <br /> v RECffEATIONAL Hi ALTm 0 SWIMMING POOL C] SPA ❑ WADING POOL 0 NATURAL BATHING PLACE <br /> 3 VECTOR CONTROL ❑ POULTRY FARM/Maximum No of Birds <br /> NN$L/Runways /Animst Popufatldn No No of Corton <br /> Irtg Canes <br /> ,.,ew,.ge Dlaposal Method _ <br /> Solid Waste Disposal Method <br /> dater Supply Source — Animal Waste Dispo=Meptoe <br /> 0 ccN*uLYA=I FEE <br /> 7 C] PLAN cNacfuma FEE <br /> O,r RM ESTATE <br /> ECUEST Weer Well InspecnonQ Samwea Title Company <br /> *" SOw"a System Inspection ❑ Adder Teti.No <br /> Escrow No <br /> Salter Seller Address <br /> Telephone No Sellar A9W Name <br /> Service Request For Dat* <br /> I humpy certify that I herr Prepsmd 11115 applloaeicn and that the work will be darts in apt 1fluince with Sep Joaquin County <br /> _ ordinances,state I and of the San Joaquin Local Hamm 01111FOUL <br /> APPLICANT$SIGNATURE a A ScLE TitM �1ES>t1tM.-�e�Lty a� lZ_ (o V) <br /> ---�_� <br /> fII POR t31111110AI1TNEW USE ONLY <br /> I Fee IS Dieu C] ANNUALLY ©Peri umr ❑0111 SITE CI sAtr1 ❑1aslaer r a ftommwiM ,31 0 jW t a a.nowr Or Jury 31 <br /> 01LUN0 A MITTANtt a / T <br /> aA51 sllrtaNAvtorr ELATE GATE AMOIiMT OW cNeca90 <br /> Aw4tlkr <br /> PEE i <br /> PnOWATION <br /> OLUS <br /> Nrr <br /> aT►tefE <br /> OTMeR <br /> . RseenoeT by <br /> e.. <br />