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DATE: <br /> (To be Completed By Applicant ) <br /> NOTE: In completing this form, use additional sheets if necessary . <br /> Answer all questions to the best of your ability. If question <br /> is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks. Incomplete forms cannot be accepted. <br /> PERSON COMPLETING FORM PROPERTY OWNER X AGENT OF OWNER <br /> Name_ Kieldsen-Sinnock & Associates, Inc <br /> Address P 0. Box 844 <br /> City Stockton <br /> State/Zip California 95201-844 <br /> Phone (209) 946-0268 <br /> A. PROJECT DESCRIPTION <br /> 1. Type of application: Q Use Permit, Q Major Subdivision, <br /> Q Zone Reclassification, Q Minor Subdivision, 0 Site Approval, <br /> Zone Variance, Q Other : <br /> 2 . Project location: 20155 & 20177 Apple Drive <br /> Describe the project; i .e. , request being made and nature of use. <br /> Identify specific project components : o adju the t�,� lina <br /> between Lots 21_ and" 22 and to div Lot 21 intoproa 0. 5 acre <br /> parcel and a 0. 4 parcel. <br /> 3 . Total acreage of project: 1_. 31 _ # of existing parcels:—1 <br /> Assessor Parcel # (s ) : Part of 019-11-07 • Lockeford Bluffs <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site , provide title and date: N/A <br /> 5 . Other permits and approvals (County, Regional, State and Federal ) <br /> required for this project: <br /> PERMIT AGENCY <br /> 1 O IJ.V: <br /> 17 - ( 8/86 ) <br /> .wl'Yla'.�iRii PY` �1Z:.1T�C/'�.Y71'r,Yr�'.. l.�X\'� 1 .. • ... ......n ..ww...... ... �...........��.���....�._ <br />