Laserfiche WebLink
"--N-� <br /> t`.=;7�"�',j..:sae. ?,v`�e`f:�.�t�'aP 4_,,3:.L.-_d3..a�-i_m.a .,iy'� � ?....{ `� .,..... :�''�.` s�.�"�`�3•�",t��§'+�:�' ..,�ir�� :,.'�r �ia"�"� :^.�##�,:r s�?x.Rs.id''�. ..Yz�?'.?''.�-;'��'�,�: <br /> R �� � �� �r ��,---�._�,��s �: WHO•MAY�At?P.L�, .4 �-,� " <br /> ONLY THE`OWNER-OF THE'PROPERTYbR A°LICENSED CONTRACTOR MAY TAKEOUT BUILDING PERMITS. <br /> Owner=Buildermust submit the following with the application: Contractor must submit the following with the application: <br /> • k-property tax statement or.a recorded deed • Current license numbers and a worker's compensation <br /> • A completed and signed"Owner-Builder Verification"form insurance. certification(this is not necessary if-this information <br /> • A completed"Authorization for Application"form if other than is already on file with the Department) <br /> the owner applies * A waiver form.if the contractor is not subject to worker's <br /> compensation laws <br /> -A completed"Authorized.to Sign"form if other than the <br /> .'contractor•applies (this is not necessary if this information is <br /> already on.file with the Department) <br /> 'a }-an4F- s'�r..,....72.srrc f „{, ,;y Yg. rs <br /> �7 ,IS P G T. $,E FILLED OUT B1(DEVELOPi�Vil 7�s C S S7 ► � CZ RV_V <br /> i�''3a„"° - c -.�.�'3aa .�h i �, a __. INFQRIVI ► ONa•' `r' ,,�� .. "., �' .�, .,�r"'•s.. �: F ,Mx <br /> i r`Job-Site Address: ' F� APN: a1 3 0,. <br /> _ <br /> Cross-Street: Ci ZIP:.. gS30 <br /> f , 1 �1_ � <br /> Precise Location: 5 E fLN <br /> � L ]ut.+n <br /> Subdivision Name: JD KM Vk ,N O Ma # '~' 1311Lot# <br /> Zoning and Setbacks:.; Zone,:AG Front: 310 Left:. Ri ht: ::L0 ear:J 0 Hei ht: <br /> School District: ':. Fire District: <br /> Sewer District: -IniLikk. Water District: <br /> 'A roved Use: <br /> Site Plan Type Hazardous Materials Survey Submitted: Yes: ❑ No <br /> MINOR:0 GENERAL:❑ MAJOR:D N/A: if answer is no-Please explain: <br /> - <br /> � Planning Protect(SA UP, MS etc.)Expiration date:.., <br /> t <br /> MONTH OW, YEAR <br /> `L Subsidence Area:Yes: ❑ Expansive Soil Area:, Yes: Nq: ❑ <br /> =Fire Hazard Area:Yes. No: ❑, Ai rt'Zone: Yes: ❑ `No:1 <br /> „ . <br /> Ente rise,Zone:: Yes: ❑ No:• SJAFCA Yes: O .. No: <br /> 'lE <br /> Required: Yes:'❑ No: BL No:: Fee Paid: Yes: ❑ . No: ❑ <br /> E)VTS <br /> . � Il.iyyA� a _ <br /> V. <br /> TER CQ ftSES: <br /> C. it <br /> ie p with San Joaquin <br /> ;jai:.ae shy respansibiiEty,of the piicant to comply with <br /> county Ordinance uo.de u Nis IZ7117, <br /> L-and Leve <br /> r ections fi 7000 throeh 6-70t�, (Sea Attached}. <br /> Y <br /> Plan Check Only YES Pile# <br /> Technician: _1 <br /> Date::to a 'og <br /> G <br /> to F:�6uud!nMHaWouWPER141TaPP—cR/WING.docFaeas2E(RevLwd+o-3o.02) Page 2 of 2 <br />