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DEMOL I TION PERMIT APPL I CAT ION <br /> !j 2 Z - 96 <br /> Date r <br /> Job Site Address City <br />' Owner /f- kPhone No.e�po� <br /> Owner's Address/City <br /> rContractors GD Phone No. 247 ��S <br /> Contractor's Address <br /> IAssessor Parcel Number_ <br /> Use of Structure C7A-9,&A11 <br /> 0:06 SAN JOAQUIN ENVIRONMENTAL HEALTH DISTRICT <br /> 445 N. San Joaquin St. , Stockton, 468-3420 <br /> WA This certifies that the Local Health District 's records <br /> (� � indicate that there is not a well or septic system on the <br /> (0 property. <br /> This certifies that the Local Health Distract has issued a <br /> well permit and/or a sanitation permit. <br /> Approval Signature _ Date <br /> Director <br /> Envaronmental Health Division <br /> AIR POLLUTION CONTROL DISTRICT <br /> ? c� TKIS 7Z 2321 W. Washington St. , Suite 1 <br /> d".4t&RC 1,lt. World Trade Center, 54!5-70a0 SQh r eL <br /> 1 -16 0',1S \:esidential <br /> his certifies that the demolition/renovation applicant has <br /> ejj� MSh atisfied Air Pollution Control District 's requirements. <br /> r� 11structures with four of less dwellings DO NOT <br /> require Air Pollution Control District approval prior to <br /> issuance. <br /> Approval Signature Date <br /> Director <br /> Air Pollution Control District <br />' NOTE: Please have the attached "Asbestos Demolition/Renovation <br /> Notification Form" complete and ready to present to APCD. <br /> - <br /> a' FOR OFFICIAL USE ONLY <br /> /�,/h6peST0 aff,��� <br /> Pacific Gas and Electric Disconnect Approval <br /> fwe 2-�-'S Name (P.G. & E.) : Date <br /> rte... ... _ �. <br />