Laserfiche WebLink
r: <br /> DEMOLITION PERMIT APPLICATION <br /> Date <br /> Job Site Address/City �Z'Aa �F - <br /> Owner �ttiR�ca ���„� _ Phone _- 4�l 3' t2`i <br /> Owner Address/City ► :L,. <br /> Contractor �� -� �.4wL �- �C— Phone <br /> Contractor Address/City 's o o Y• �5 �.�1 a 1 <br /> APN Use of Structure PZ <br /> 1 certify that I will dispose of all demolition materials at an approved recycling facility or land disposal site. � <br /> Signature _�''i---- o", ,., ate— �..,y, , c�-- <br /> - I <br /> N <br /> SAN JOAQUIN ENVIRONMENTAL FIEALT14 DISTRICT <br /> 304 E.Weber Avenue,Third Floor, Stockton CA(209)468-3420 <br /> WELL: <br /> ❑ Site is served by public water. ❑ No record of a well on site. ❑ Previously destroyed under permit. + <br /> ❑ Per applicant,well is to be retained and used for other structures/irrigation;well is in good repair and able to <br /> to function as originally designed. (Pump must be in place and have power.) <br /> ❑ Well is to be taken out of service under permit and will be placed back in service within five(5)years. Wells <br /> not returned to use within five(5)years must be destroyed under permit by a C-57 licensed well driller. <br /> W 11 is t be destroyed under permit by a C-57 licensed well driller. yr S <br /> SEPTIC' Vj^ <br /> ❑ Site is served by public sewer. ❑ No record of a septic on site. ❑ Previously destroyed under permit. <br /> Septic tank(and/or brick lined open seepage pits)to be destroyed under permit. ' <br /> Septic tank to be retained for exiting structure that is currently using the system. _ <br /> ❑ Septic tank to be retained under out-of-service permit for new replacement construction to be built/installed <br /> within one year from this date. !� ' <br /> Permit Type Permit# � I Date issued i <br /> Permit Type Permit# Date issued <br /> Environmental Health Division Approval Signature ssued <br /> I <br /> Public Works Department Approval Signature Date issued <br /> SAN JOAOUIN VALLEY UNIt'IED.AIR POLLUTION CONTROL Dt,�-rw.T <br />