HomeMy WebLinkAboutDM070119 - ASBETOS 10.04.2007 . Asbestos Disclosure for Demolition Project
Date: I r) , ,-4 • a
Applicant Name: C'0! 5, 6'VA-e— < 12[ c '- ^'1�--L-1 1
Applicant Address: 'S'7 C) &C A4'a"r' /
Applicant telephone Number: -2. '7oz)
Job Address: t�
Unincorporated Area of Orange County Zip Code
Demolition Permit Application Number:
IdI declare that the demolition of the structure which job address is listed above does not
involve demolition or removal of any asbestos material. Written asbestos notification is not
applicable to the demolition project.
❑ I declare that the demolition of the of the structure which job address is listed above does
involve demolition or removal of asbestos material, and attached is a copy of each written
asbestos notification regarding the building that has been required to be submitted to the
U.S. Environmental Protection Agency.
4
Signature of Authorized Agent or Owner:
County Of Orange
Planning and Development Services Department ASBESTOS DISCLOSURE
Central Office Inspection Office for
P,O. Box 4048 22921 Triton Way
300 N.Flower Laguna Hills,CA 92653
Santa Ana,CA 92702 (949)472-7979 DEMOLITION PROJECT
(714)834-2626
ez'.asbestos.doc(05/20/02)