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SAN JOAQUIN COMMUNITY DEVELOPMENT DEPARTMENT <br /> i Ni v- ___ ROAn 1115bw5 <br /> %E <br /> PRE-APPLICATION: ❑ <br /> Applicant Information Applicant Representative Information <br /> Name:Joe&Jill Dutra Name: 0 c" J z /-CA <br /> Mailing Address: 29361 Grooms Road Oakdale Ca Mailing Address: Z GJ 3 (o f Z;l• S R 1--)C11oI <br /> 29361 Grooms Road Oakdale Ca of C'�n <br /> Phone:209-838-2019 Phone: ZD <br /> Email: ji.Crc_LA4, <br /> .+.+ AeliiC"t-ro. Email: �/Y,l�i h� V lac C, ✓1 f <br /> Proposal <br /> (Attach additional sheets as necessary) <br /> ❑ Public <br /> Public or Private Road (check only one, separate applications <br /> or <br /> required for each): <br /> ■❑ Private <br /> Existing Road Name:none 7- <br /> Proposed Road Name:Jill. lue-Ery Q— <br /> Location of Road: 29384 Lone Tree Road, Escalon, Ca. 95320 <br /> 29384 Lone Tree Road, Escalon,Ca. 95320 <br /> Reason for Request: to name a new private road <br /> to name a new private road <br /> Related Planning Application(PA)number(s): <br /> Is this application tied to Private right of way <br /> another discretionary Yes: ❑ No: ❑ <br /> application? 11014Z 2 O 3 6-1 <br /> All property owners with access on road must agree to proposed road name <br /> (For Private Road Name Change Only) <br /> APN Address Owner's Name Signature <br /> 229-130-30 29384 Lone Tree Road Joe L Dutra <br /> Jill R Dutra <br /> APPLICANT SIGNA RES <br /> Print Name: <br /> Joe L. Dutra Signature: Date: r L 2 L <br /> Print Name: JIII R. Dutra Signature: rA Date: -2-11 <br /> Z <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Page 1 of 1 <br /> 0210412022 <br />