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' L"'1J 1\i•i1� Cal ♦ y,,i.,.ly+t.i., <br /> 1.j Ll <br /> Da to 1/ <br /> -� Job Site Address City_ / <br /> Phone No. <br /> ;1 <br /> Owner <br /> Owner ' s Address/City <br /> Phone No. <br /> Contractor <br /> Contractor' s Address <br /> Assessor Parcel Number <br /> Use of Structure <br /> Public <br /> Water System: <br /> Private �] <br /> Sewer System: <br /> Private E] Public <br /> Before a Demolition permit can be issued by the Building <br /> 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 /> k SAN UOAQUIN LOCAL HEALTH DISTRICT: <br /> This certifies that the Local Health Districts records v " <br /> indicate that there is not a well or se tic s, stem on the <br /> property. ' <br /> This certifies that the Local health District has issued a <br /> well -Rermit and/or a sanitation permit. CS ��L- <br /> Comments : <br /> I <br /> �-�--_ Dat , <br /> Approval Signature Director <br /> n Valinoti , <br /> Environmental Health Division <br /> AIR-POLLUTION-CONTROL DISTRICT: <br /> molition/Renovation applicant has <br /> This certifies that the De <br /> satisfied Air Pollution Control District' s requirements. <br /> This certifies that the Demolition/Renovation application is <br /> exempt from the Air Pollution Control Distrilct' s requirements. <br /> i <br /> Comments : <br /> Da to <br /> Approval Signature <br /> La hmzr Grew a , Director <br /> Air Pollution Control District ' ( 5/88 ) <br /> AI <br /> ��1 <br />