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011 via— & s-L <br /> G DEMOLITION PERMIT APPLICATION l�Qt�� a, - <br /> Date /1791 <br /> Job. Site Address/City <br /> O w n e r- ,_.Pe►,r/C_✓ `e �_ Phone No. <br /> Owner ' s Address/City 02�3/0 OI✓1 <br /> Contractor Phone No. <br /> Contractor ' s Address <br /> Assessor Parcel Number <br /> Use of Structure__ <br /> 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 hermit and/or a sanitation permit . <br /> -3aod <br /> I <br /> Comments : 00 <br /> itOAAp,pro,val S - a e6 <br /> Ron Va inoti , Direct ' <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_ Da Date- — <br /> Lakhmir Crewal , Director <br /> Air Pollution Control District <br /> ( 5/88) <br />