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APPLICATION - SECOND UNIT DWELLING
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br /> FILE NO.: SD- -
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<br /> Name: Name:M 5 AT 00.5146 of l..N(((&?tJiA
<br /> Address: Address: �c Q 09-- 568
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<br /> Phone: �/ ��3,s-0,—T Phone:
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<br /> Description of the proposed project:
<br /> Occupants)- Name: Age:
<br /> Name: Age:
<br /> Square Footage of Second Unit Dwelling:
<br /> Year Mobilehome constructed ('d applicable):
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<br /> Assessor Parcel Numbers) Property Size Williamson Act
<br /> Contract
<br /> ❑Yes No
<br /> Property Address: SQA{
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<br /> Onsite Uses (Include r...
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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 ❑
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<br /> Public Storm Service Provider(d Public) Annex-Formation Terminal Drainage Detention-
<br /> Drainage❑ Required to: Retention Ponds
<br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑
<br /> Drainage❑
<br /> .................:::........
<br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks
<br /> S! ! Yes❑ No Yes❑ No
<br /> Yes❑ No❑ Yes❑ No❑
<br /> -2-
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