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, ) , r <br /> 4. .N <br /> K � <br /> DEMOLITION PERMIT APPLICATION <br /> Date <br /> Job Site Address/City <br /> II <br /> Owner V(O 30 /y 'j—�Oy VL }� " 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 /> An <br /> SAN JOAQUIN ENVIRONMENT 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 <br /> ry eUr,u-ko --, S,+t <br /> (\/o This certifies that the Local Health District has issued a <br /> well permiitt and/or a san tation ermits76V-9 �-`1z c <br /> �iDk�- L.��n�e,� its lie �?6t t� v L� - f o Fh �a'41 <br /> Approval Signature Date �_ <br /> Donna Heran, Director (, F " <br /> Environmental Health Division <br /> i <br /> BAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT <br /> 4230 Kiernan Avenue, Suite #'130, Modesto (209) 545-7000 <br /> i <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. Raid, Director of Compliance, San Joaquin valley <br /> unified Pollution Control District <br /> Approval Signature: Date: <br /> Printed Name: Title: <br />