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DEMOLITION PERM T APPLICATION <br /> Date <br /> Job Site Address/city /Y <br /> Owner Phone No. .3 6 <br /> Owner's Address/City— <br /> Contractor f Phone No. <br /> Contractor's Address , <br /> Assessor Parcel Number /� - /S C -� / <br /> F <br /> Use of Structure <br /> f <br /> SAN JOAQUIN ENVIRONMENTAL HEALTH DISTRICT <br /> 304 E. Weber Avenue, Third Floor, Stockton 468--3420 <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. V-,,� 40 /�Q.W��-�V� — 5{z (,� (KC4 <br /> This rtifies that the Local Health Di�ict has issued a <br /> f ,, well ermit a door a sanitation permit <br /> V U vvM -�o V-19 /Le c gid' `Vn..t It 01 V.Cf Y V-.,(4�, Ili (a VV <br /> Approval signature Date ILI <br /> - <br /> Do na Heran, D rector <br /> Environmental Health Division - 01 { <br /> r <br />` <br /> BAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT <br /> 4230 Kiernan Avenue, suite x'130, Modesto (209) 545-7000 { <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 />