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APPLICATION - SECOND UNIT DWELLING
<br /> ` . SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Owner lnfortatbn Appllcarti Fnformatiort'`
<br /> Name: /j/)') Name: SiQ/n
<br /> Addr D ['IW �� v Address:
<br /> Phone: / 0 3—A/ Phone:
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<br /> Description of the proposed project: �9&_L42271,201 L 1X ✓
<br /> 6D a cr 7_67206
<br /> Occupant(e)- Name: Age:
<br /> N e: Age://0 /_
<br /> Square Footage of Second Unit Dwelling:
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<br /> Assessor Parcel Number(s) Property Size Williamson Act
<br /> Contract
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<br /> Onsite Uses(Include Ag Crops):
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<br /> Service Provider Annex-Formation Distance to Public
<br /> Public Water❑ Required Water(Feet)
<br /> Private Water❑ Existing Well New Well ❑ Well Replacement ❑
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<br /> Public Sewage Service Provider Annex-Formation Distance to Public
<br /> Disposal❑ Required Sewer Facility
<br /> On-site Sewage Existing Septic System ❑ New Septic System Other ❑
<br /> Disposal IBS
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<br /> Public Storm Service Provider(H Public) Annex-Formation Terminal Drainage Detention-
<br /> Drainage❑ Required to: Retention Ponds
<br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change ur**" Other ❑
<br /> Drainage❑
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> Yes❑ No MX Yes❑ No
<br /> Yes❑ No❑ Yes❑ No❑
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