Laserfiche WebLink
/ Y <br /> i 1 <br /> r. < <br /> DEKOLITIOH PERMIT APPLICATION <br /> Date <br /> Job Site Address/City /W3 /Y TI-1D1,-1V101y <br /> Owner r Phone No. <br /> Owner's Address/City <br /> Contractor Phone No. <br /> Contractor's Address , <br /> I n <br /> Assessor Parcel Number /S-0 — / 7 <br /> Use of Structure <br /> i <br /> SAN JOAQUIN ENVIRONMENTAL HEALTH DISTRICT <br /> 304 E. Weber Avenue, Third Floor, Stockton 465-3420 <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 /> This rtifies that the Local Health Diict has issued a <br /> well ermit ,;,a,p d/or a sanitation permit.�i <br /> �DVv�2s3 div n� � r�er� -d e u lC ( �Cf <br /> Approval Signature OA �} j;- P Date-Z17- /q -�J`J <br /> j Doha Heran, Director /�Air-e,v� 1 <br /> Environmental Health Division <br /> SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION CONTROL DISTRICT <br /> 4230 xiernan Avenue, Suite #130, Modesto (209) 545-7000 <br /> ( ) This certifies that the demolition/applicant has satisfied the j <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. xard, Director of Compliance, San Joaquin Valley <br /> Unified Pollution Control District <br /> I <br /> Approval Signature: Date: <br /> Printed Name: Title: <br />