Laserfiche WebLink
DEMOLITION PERMIT APPLICATION <br /> . <br /> Date----_--q !5l_ -- <br /> Job Site Address/City__ 5a_31 <br /> 1 � . r_0( e �y - �Un-' <br /> Q� fw ✓Q�{i( Phone N o. <br /> Owner ' s Address/City_�? 3 �__ G—(lt `C - <br /> Contractor --_-_ -- -- _ —_ Phone No.-- <br /> Contractor ' s <br /> o.Contractor ' s <br /> Assessor Parcel Number-- <br /> Use <br /> umber _Use of Structure--- <br /> Water <br /> tructure -Water System: Private Public <br /> Sewer System: Private Public <br /> Before a Demolition permit can be issued by the Building Inspection <br /> Division , approval signatures must be obtained from each agency <br /> listed below. It is the applicant ' s responsibility to obtain all <br /> signatures and return this form to the Building Inspection Division. <br /> --------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT : <br /> This certifies that the Local Health District ' s records <br /> indicate that there is not a well or septic system on the <br /> property. <br /> This certifies that the Local Health District has issued a <br /> well -permit and/or a sanitation permit . <br /> Comments :_------------------- -- ---- - — <br /> Approval SignaturAn <br /> � �� Date�3-Cl^ �� <br /> Valinoti , Di ector <br /> Environmental Health Division <br /> -------------------------------------------------------------- <br /> AIR POLLUTION CONTROL DISTRICT : <br /> This certifies that the Demolition/Renovation applicant has <br /> satisfied Air Pollution Control District ' s requirements. <br /> This certifies that the Demolition/Renovation application is <br /> exempt from the Air Pollution Control District ' s requirements . <br /> Comments : _—__ <br /> Approval Signature_________________- Date- <br /> Lakhmir Grewal , Director <br /> Air Pollution Control District <br /> ( 5/88) <br />