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SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO.: SD-It 3 - D <br /> ;.Tp q CAMP I"7 p Y iti tl.Ppl.iCAN�PRsAR70i�1DN�r'FHEAP A I44:: : ::: <br /> Owner Information Applicant Information <br /> Name: <br /> Address. - Address: <br /> i ` iC <br /> Phone: ( Phone: r <br /> r <br /> . t�> + cr tI=sGprt�t <br /> .... <br /> Description of the proposed project: <br /> Occupant(s) - Name: ,Liu 1, Int'I Lu o Age: <br /> Name: � 7 I 1 G� _ C ti Age:. <br /> Square Footage of Second Unit Dwelling: <br /> Year Mobilehome constructed (if applicable): <br /> �:::<•;::> . . ... .: <br /> . <br /> ........... <br /> ft'do.p 1�►1os"*'.&". s <br /> Assessor Parcel Number(s) Property Size Williamson Act <br /> Contract <br /> ❑Yes ❑No <br /> Property Address: " <br /> ..... ::. . .::.:.:::::...: <br /> .:.:::. ::::;......... . . . <br /> >:::(VHd <br /> ... ::.::.:::..:......:.:::.:.:......::::::::::::::::..::::::::::::::::..::::::::::::::::.:::::.:::::::: : <br /> On-Site Uses (Include Ag Crops): <br /> . � ��y�+ <br /> � .. rt+� <br /> ... <br /> . <br /> . <br /> 1Haiet ;:;:;:«::: <br /> Service Provider Annex-Formation Distance to Public <br /> Public Water,{ Required Water (Fact) <br /> Private Water❑ Existing Well ❑ New Well ❑ Well Replacement ❑ <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal 0, Required Sewer Facility <br /> On-site Sewage fisting Septic System ❑ Now Septic System ❑ Other ❑ <br /> Disposal❑ <br /> a:' <br /> 8torna F7aa1a <br /> s:: ... <br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detenticn- <br /> Drainage❑ Required to: Retention Ponds <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change ❑ Other ❑ <br /> Drainage❑ <br /> : . Rce> <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter/ Sidewalks <br /> Yes❑ No C] Yes❑ No 11( <br /> Yes❑ No❑ Yes❑ No C� <br /> -2- <br />