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APPLICATION - SECOND UNIT DWELLING
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
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<br /> Name: Name:
<br /> Address: ef Address:
<br /> 1A- s3 ,(Z4 f�C440 COO✓A- 0A 9
<br /> Phone: Phone: 6 ?)g
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<br /> Description of the proposed project:
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<br /> Occupant(s) - Name: ` L1C f� /�/, �,¢-�,��Q Age:
<br /> Name: V�� I i �� Age: Z�
<br /> Square Footage of Second Unit Dwelling:
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<br /> Assessor Parcel Number(s) Property Size Williamson Act
<br /> Contract
<br /> �-S 7 ZZO 3 �, 6 7 ❑Yes o
<br /> Property Address: IL
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<br /> OnSlte 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 /> Orrshe Sewage Existing Septic System New Septic System ❑ Other ❑
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<br /> Public Storm Service Provider(if Public) Annex-Formation Terminal Drainage Detention-
<br /> Drainage❑ Required to: Retention Ponds
<br /> Private Stor On-aite Retention Pond(s) [3 Natural Dralnage/No Change Other ❑
<br /> Drainage
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<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> QST Yes❑ No Yes❑ No
<br /> Yes❑ No❑ Yes❑ No❑
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