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Ip <br /> DEKOLITION PERKIT APPLICATION <br /> •1}s�f'ii*t <br /> Date <br /> � a <br /> Job Site Address/City ,�,,�7 c,4 z- &j !1 .3 <br /> 64 <br /> Owner4-f& ,4 Phone No/-20" <br /> Owner's Address/Cit <br /> Y �- L �,��=.��. /!7oni,- Z:0 Cly 2j-2,57 <br /> Contractor I Phone No. <br /> Contractor's Address <br /> Assessor Parcel Number ] <br /> Use of Structure) .— <br /> SAN JOAQUIN ENVIRONMENTAL HEALTH DISTRICTC'� <br /> 304 E. Weber Avenue, Third Floor, Stockton 468-3420 <br /> S ( I <br /> { ) This certifies that the Local Health District's records, 1+ <br /> indicate that there is no a ]well or -septic ovstem anthe ' <br /> property. Q \�ak <br /> ( ) Thi certifies that the Local He Dist'c has issued a <br /> well permit ;and/or a sanitatio permit. <br /> Approval Signature \-Pl4a Date ( � � <br />` <br /> Donha Heran, Director <br /> i <br /> Environmental Health Division <br /> 1 { <br /> BAN JOAQUIN VALLEY NIFIED AIR POLLUTION CONTROL DISTRICT <br /> 4230 Kiernan venue, Suite #130, Modesto, (209) 545-7000 <br /> I� <br /> { ) This certifi that the demolit on/applicant has s i Pied the <br /> -APCD'9 re irements. The CD allows the molition to <br /> r proceed or after , 19 <br /> F { ) This ertiEies thatthe molition applic ion is exemp from <br /> th APCD's requirement <br /> Comments: <br /> For Robert Kard, Director ComplianctDate: <br /> oaquin Valley <br /> Unified P lotion Control - strict <br /> Approv 1 Bigna*ore: <br /> I \ _ � <br /> Printed Name: Title: <br /> ti <br />