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� COMMUNITY ®EVEL PMENT DEPARTMENT <br /> N JOQQUI STV SATE APPROVAL/USE PERWT <br /> COU <br /> rea ass gro`4s here, <br /> FILE NUMBER:'; <br /> PRE-APPLICATION: ❑ <br /> fOwner Information Applicant Information <br /> Name: Se M4400,;!1 U.P_P , &).b Igme: �TI MM f{7A vv XI A-iia u <br /> Mailing Address: Lt:WZI ov cc—V19VC Mailing Address: 44L7J.5 ����/ �L► �1'�1�v <br /> Phone: ( I? Phone: ®` <br /> Email: M(li 1,7 t tfi 00 • C r3M Email: C/1C�td ''D'1�M o /a e C'� C'Del <br /> Applicant's Representative Information Desfg4 Proffessional Information <br /> Name: Gm� ij /a4-mAl }¢ll Name: y 6/Name: SSOC1'1�1LLs <br /> Mailing Address: © eA2f,6Cr�4J&fes C10 Mailing Address: �� �tl v S% �`�f3 <br /> Phone: Df/� / — /_3O Phone: SP2- <br /> Email: lictidc# .,kv,M L Email: <br /> Project Description <br /> (Attach additional sheets as necessary) <br /> 9.Site Approval <br /> Type of application (check only one, separate applications <br /> required for each): or <br /> Ise Permit <br /> Project Summary: 46_ ,d1AJ 1 A.),9 OD14 /��-Ar7�?7'1& � �d 0� 3oss- S j <br /> e!!—::7X i�i l ied`f 6 C1i4,6 i AJ i _ - -- — -- - <br /> Will the project include more than one (1)phase? (maximum of 2 phases)Yes: ❑ No: <br /> Length of time (maximum of 5 years): ,ter /-MV--7 <br /> Note:For questions regarding phasing,contact the Planning Division at 209-468-3121. <br /> Related Planning Application (PA) number(s): IV CQ <br /> Is this application tied to another Yes: ❑ No: � APAP 0! J �A Q yg03,r <br /> discretionary application? <br /> Property Information <br /> Assessor Parcel Number Property Address Property Size Williamson Act Contract <br /> Yes: ❑ No: , ] <br /> Yes: ❑ No: ❑ <br /> Yes: ❑ No: ❑ <br /> Page 1 of 6 <br /> 08/1312021 <br />