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"..".,'.,.,··.:.._.,.F -s-'.,,.'.-"..'...~ <br />'.WHO MAY APPL Y.?,".",..: <br />ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. <br />Owner-Builder must submit the following with the application:Contractor must submit the following with the application: <br />•A property tax statement or a recorded deed.•Current license numbers. <br />•A completed and signed "Owner-Builder Verification"form.•A completed "Authorized to Sign"form if other than the <br />•A completed "Authorization for Application"form if other than contractor applies (this is not necessary if this information is <br />the owner applies.already on file with the Department). <br />:(HIS PAGE TO BE FILLED OUT ~Y DEVELOPMENT SERVICES STAFF .. <br />. <br />PROPERTY'INFORMATION <br />Job-Site Address:I Ot'5 7 E'.~:Lt.+4/&/1 cI !f~APN:2.08 -()5()-/X" <br />Cross-Street:5 /lu.('f/~fl //1 City:J.{C-tA -Iec»;ZIP:7'<)(,'7..~ <br />Precise Location:rJA fAe it rJ.-;J..)jd~o -('IE S'o,.#.l.n d Ilc'!" <br />I KC'l)-tee +eAr.f ()-(?5 At:...r ~//I'1./7",~~t1//.-Ipc ~ <br />Map# <br />/ <br />Subdivision Name:--BI/Lot# <br />Zoning and Setbacks I Zone:J1~-yC)I Front:30 Left:/0 I Right:/()Rear:is-I Height:/:? <br />School District:IiU /I -f e'('~Fire District:c.:+t'y(,,£J n:...-l-»....• <br />~Sewer District:s-:«.Water District:WoJ/ <br />Approved Use:~~j 'JJrJ:"Jv rJ!IL .j-eI.r LA<'~.c. <br />~ <br />I <br />SPECIAL AREAS <br />Subsidence Area:Yes:0 No:¥Expansive Soil Area:Yes:0 No:.:a. <br />Fire Hazard Area:Yes:0 No:0 Airport Zone:Yes:Z No:0 TLrk-l./\\l1~ <br />Planning No:SJAFCA:Yes:0 No:~I <br />r-: <br />COMMENTS <br />~o.P-oho lI-b~~ <br />12-$'~-f:1L7 de f 4/'1.("~n i':'~'>Y\>I;/~i()YJ <br />, <br />r-r If :) <br />A"-A "6~7'Eb .di ,JL I-It?~J~es:'i'11~5;::./2- <br />sr -:"Ln/~l 7?"-T (-- <br />_n_•. <br />.A PD:t).~\I ?'I 'fA <br />(f:;::l(T ,r-/ <br />Th'-'v """•••••,f~;;.pproval exten'd~'rlI''1,",~••.'-•.I <br />~lt;}t;cnDed hereon ,.'·t d ','-"'"..••.vv i Hl,;fl IS snown ~'1d <br />:::In",".'lJU G6S not tillfh,,,,\r.,.o "..~ <br />.:"~1.x:.IVII {lr aeVlatlon f''J :,"-jJl<..JveWORKSnr=OJ\OTl\I1r-•.•-e-0 reqLArer.-'t:,nts of PI JRI Ir <br />FI,nt.'tn ...•,....,•.,•...-IVIL-l~I,\..Ioumy Of San Joaquin. <br />-""•••L-..,"-c <br />Uate 8 -28 -90 ~/--By -c.~/.bL/ <br />/C/ <br />Plan Check Onlv ()YES File#/ <br />Technician:rLC-Date:~/2-f?/O~ <br />I I <br />F:l6uilding\Handouts\PERM1T APP-Residential.doc File .122 (Revised 10-30-02)Page 2 of2