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J <br /> atiq�L.N <br /> DEMOLITION PERMIT APPLICATION <br /> Date <br /> Job Site Address/City <br /> I <br /> Owner _ 6jc) tV �}/1 -� Phone No. <br /> Owner's Address/C ty <br /> contractor Phone No. <br /> Contractor's Address <br /> Assessor Parcel Number <br /> Use of Structure <br /> ja.nDcx'(r <br /> SAN JOAQUIN ENVIRONMENT , HEALTH DISTRICT <br /> 304 E. Weber Avenue, Third Floor, Stockton 468--3420 <br /> .ter <br /> ( } This certifies that the Local Health District's records 400 <br /> indicate thatthere is not a Well or septic system on the <br /> property <br /> ryerty00 <br /> (�o This certifies that the Local Health District has issued a <br /> well permit and/or a sanitation ermit-c7&--e FIZZ <br /> Approval Signature(=( -Date- <br /> Donna <br /> ateDonna Heran, Director �, <br /> Environmental Health Division1 � <br /> eA <br /> f <br /> SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT <br /> 4230 Kiernan Avenue Suite 130 ' Modesto 209 545- 0 <br /> �` , ( ) 7 0 0 <br /> ( ) This certifies that the demolition/applicant has satisfied the <br /> APCD's requirements. The APCD allows the demolition to <br /> proceed on or after , 19 <br /> ( ) This certifies that the Demolition application is exempt from <br /> the APCD's requirements. <br /> Comments: <br /> For Robert J. Kard, Director of Compliance, San Joaquin valley <br /> Unified Pollution Control District <br /> Approval Signature: Date: <br /> Printed Name: Title: <br />