SU0002188 - Laserfiche WebLink

Home Browse Search

DEMOLITION PERMIT APPLICATION Date ID Job Site Address/City �j �� TzT, /5 Owner N Phone Owner Address/City f Contractor tl"r �EZOJI�E Phone f Contractor Address/City APN 01e3 -LCA 13 Use of Structure SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION - 304 E WEBER AVE,THIRD FLOOR, STOCKTON CA WELL: (209)468-3420 ❑ Site is served by public water. ❑ No record of a well on site. ❑ Previously destroyed under permit. Per applicant, well is to be retained and used for other structures/irrigation, well is in good repair and able function as originally designed. (Pump must be in place and have power.) LJ f Well is to be taken out of service under permit and will be placed back in service within five (5) years. Wells not returned to use within five (5)years must be destroyed under permit by a C-57 licensed well driller. ❑ Well is to be destroyed under permit by a C-57 licensed well driller. SEPTIC: Wt`s GA4.4i 'T9 Its D E1nAL4i'MI ❑ Site is served by public sewer. td No record of a septic on site. ❑ Previously destroyed under permit. ❑ Septic tank (and/or brick lined open seepage pits)to be destroyed under permit. ❑ Septic tank to be retained for existing structure that is currently using the system. ❑ Septic tank to be retained under out-of-service permit for new replacement construction to be built/installed within one year from this date. PERMIT TYPE t CSL PERMIT# JQOo -�(p DATEISSUED PERMIT TYPE PERMIT# DATE ISSUED Environmental Health Division Approval Signature QIA—) _ Date t 1�OT 2-Z� D'Ep a CML SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL OISTRICT 4230 KIERNAN AVE, SUITE 130, MODESTO CA (209) 557-6400 ` ❑ This certifies that the demolition/applicant has satisfied the SJVU APCD requirements. The APCD allows I the demolition to proceed on or after ❑ This certifies that the Demolition Application is exempt from the SJVU APCD requirements. Comments: Approval Signature i Date ' Printed Name Title DEMOPRMTCCD 09105Ip0