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A4 <br /> APPLICATION CONTROL SHEET A <br /> > �at� '�.��'��'a '` � i � �� �>�;�,Couple(e �yDeytetnpmw�5cvicaStaff' �..r�*� "x � ���a'K'"�:•��'�,' � <br /> Psvlpp:❑Yo❑No Fee Roerjpt Number. Data <br /> m. Numb. Foe x GS.w Raoeipt Number. ('L07S Data ✓L I U <br /> Tae Numb. Foe Receipt Number. Data <br /> File Number: Foe Receipt Numb. Data <br /> Project Description Lcor (,,"-c D*Q7WCN - t�`k(5 rlNG <br /> pica s . !?co�1 1-2''- (30- 07 `-ter '3,s (EKJ--N-ILC� 5-0 A-r,cF Ta <br /> A-ty) 4Pj 1`T 4-130 oro 'Tv t3E PL-'1Rfc.w i? M �b.Ser A-C,c-3 <br /> -rp -7.S7 A--2 . <br /> Project Lotallon: U r 1 � <br /> Address: -3 N 12 S Pa,, <br /> Vec..� Lew` (5- L-J APN(.) 3 c)-c)7, o <br /> Enterprise Zone o❑No General Plan Designation: L <br /> Property Zoning: -f�+'-Z� Zoning Map.5T7xk.--a^4 S.C• General Plan Community. <br /> cd .....F. ,:Ya <br /> ` A3laanfTandllsrz�,al .:GeneialPlan <s , <� ,:W <br /> Nonh 0-Zv <br /> South: (21t- &U-20 <br /> East: VEIL. At1-2-v <br /> West RI L /X Q-2 rJ <br /> 100-Year Flood❑Yea i to Zone: k U-'l.c Williamson Act❑Y,?❑ . Prime Soil❑Yes❑No❑NA <br /> Airport Area ❑No Specific Plan(s)❑YcpGNo Supervisorial <br /> Name: Road Name: D stricC�_ <br /> History. <br /> ���x�Rxiy•� � •�'�fi� k '����iCKL�S'T A��` Pl:ff:X*CItlN5'�f:�.�"'�� "'��'�` ��_> <br /> Completed Applications Forms -0, Owner or Agent Signature <br /> Copy of Deed or Preliminary Title Report' 14- Hazardous Materials Disclosure o <br /> 8 1!1'x 11'Reduced Plan or Map ',R� Copia of Plan or Map �{ <br /> Soils Suitability Study' ❑ Assessor and History Pages <br /> General Plan Map'/Toning Map* ❑ Soils Report• ❑ <br /> Subsidence Area❑Yes o Expansive Soil es❑No <br /> �� * RTA�LS1�01~REQUI�REAFAT'WUM TAII[ PGIC QNS � R � x <br /> x r 3�` iF!'CT(014 T+tw/�6 F F5R T)ETAILS s�z ` sr a.,a� yz cF <br /> .,F.,,.,...,,..v..> ,.......,,o,. .. <br /> ^�. 0s k, .e'"°, r'.z sv , vu ;; t� bm�7�,.ay�,$ x'x3"�e � s�.S ago=3 ::"�ha�::' <br /> 4a <br /> Map Signed By Owner ❑ Tract Number and Name(Major Subdivisions Only)❑ <br /> Adjoining Property Owners Names on Map All Lots Numbered ❑ <br /> Contour Unes Location Well&Septic <br /> _ �� s $jCCA <br /> ^`? <br /> �f11145a� a, za .amt°a�� � <br /> ..:.... h :> s.. .m <br /> Reclamation Plan and Schedule ❑ Financial Guarantee O <br /> Typical Cross-Sections ❑ Elevation Calculation ❑ <br /> Engineces Stamp ❑ MR.Z❑Yes❑No <br /> Completed Dy. ink ,G �A. —(�1'LL� Date 2 <br /> troLka <br />