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CERTIFICATE OF OCCUPANCY ROUTING FORM <br /> Permit Number: 1-7 �)OQ`7 Assessor Parcel No. 2,07 -320 - <br /> Use of Structure: LVVe,5-1DJ<- MCM+tom. C /\tilt lton <br /> Address of Structure: 2552>s L • L©'ne• .II cG ttcl. FSca[on CA T5320 <br /> Dwner: ��irLlel Mucha o Address: 132a rr�m Aye . , �s�-? o L� `��3.2 <br /> Doing Business As: <br /> Contractor: Jin (=��fYdcYlr,�c ans-k Tnc• Contact Phone No. : �ZO)) <br /> Dcc. Group: A-3/[3-2- Type of Constructio : V-4] Fire Sprinklers: �S <br /> Square Feet: p Occ. Load: 0 Z'07117)- Area Separation Wall in Lieu <br /> zoning: Ca _?vof Sprinkler: <br /> tefore a final inspection can be made by the Building Inspection Division, and prior to issuance <br /> if a Certificate of Occupancy by the Building Official, APPROVAL SIGNATURES must be obtained from <br /> 3ach agency listed below. It is the applicant's responsibility to obtain all signatures and <br /> return this form to the Building Division. Please be aware that advanced notice and field <br /> inspection time may be required by each agency prior to signature. If your project is in a flood <br /> sone, Flood Control must have the Elevation Certificate properly signed before approval can be <br /> 3ranted. NOTE: Please bring your approved Development Plan or plot plan when obtaining <br /> Signatures on the Certificate of Occupancy Routing Form. <br /> )evelonment Services/Engineering: <br /> Approval Signature Date <br /> TOM GAU <br /> SENIOR CIVIL ENGINEER <br /> Comments: <br /> ?ublic Works Department: <br /> Approval Signature CA 1) Date 4/8/iZ <br /> PUBL C WO"S bEPARTMENT <br /> Comments: lbelq AItMU4 O!2r� - c2rj /ID/I?/q/ --� <br /> San Joaquin Public Health Services: <br /> Approval Signature v�� Date ,tZ <br /> RONW VALINOTI, DIRECTOR <br /> ENVIRONMENTAL HEALTH D VISIQN <br /> Comments: � ,aye- . <br /> kir Pollution Control District: <br /> Approval Signature Date <br /> LAKHMIR GREWAL, DIRECTOR <br /> Comments: <br /> ;an Joaquin County Fire Warden or Applicable Fire District: <br /> Approval Signature Date <br /> STEVE THIENES <br /> COUNTY FIRE WARDEN <br /> Approval Signature Date <br /> APPLICABLE FIRE CHIEF AND <br /> FIRE DISTRICT <br /> Comments: <br /> /91 <br /> 'n.DOC/LC <br />