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APPLICATION - SECOND UNIT DWELLING <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SD- - <br /> AfJ7t10R17A1ION MNAC1JRE8 <br /> ONLY THE OWNER OF THEPRopiall Y OR AN AVMORfZE0 AGEW MAY PILE AND APPUCA171144 <br /> SIGNATURE: I cortify under penalty of perjury that I am (chock one): <br /> &L Legal property owner (owner Includes partner,trustee,trustor,or corporate officer) of the property(s) <br /> Involved In this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's Involved In this <br /> application and have been authorized to file on their behalf., and <br /> that the foregoing application statements are true and correct <br /> SIGNATURE: I certify by my signature that I have read and understand the Second Unit Dwelling Standards: <br /> Signature: c, Date: - ,q 7, <br /> Signature: D.W Q�v7. <br /> Signature: Da.: C <br /> sigrLature: Deter <br /> Stpnawm: DxtoK <br /> STAFF USE ONLY <br /> i V 1 QP1itEMr1 SEffiY1Cf S )E'U IG Wows ENNiHUN11t:.M�`AL HEALTH <br /> PROPOSAL APPROVED SUBJECT TO: PROPOSAL APPROVED SUBJECT TO: ❑ <br /> 2, Project meets zoning requirements 1. Encroachment Permit ❑ 1. Sanitation Permit ❑ <br /> for both use and construction: 2. Traffic Mitigation Fees: 2. WolUpump Permit ❑ <br /> Yes❑ No❑ 3. Change Noted: ❑ <br /> 3. School District Fees ❑ <br /> 4. Fire Facility Fee ❑ PROPOSAL DENIED: ❑ <br /> 5. Flood Fringe ❑ <br /> 6. Subdivision History 3. Flood Control Conditions: 4. Remarks: <br /> 7. Remarks <br /> 4. Remarks: <br /> Dato: By: Date: By: Data: By: <br /> Second Unit Dwelling Address: <br /> — -3- <br />