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Mo be Completed Ly 1' li nnt ) <br /> NOTE : In completing this form, ust2 additional sheets if riocc�ssary . <br /> Answer all questions to the be:,t of your ability. Lf question <br /> is not applicable to your project , write NA ( not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be accepted. <br /> PE14SON comPLE.TING FORM _--PROPERTY OWNER -_X_AGENT OF OWNER <br /> Name-___ --TerrPiazza__ <br /> Address 323 W. Elm Street <br /> City_ Lodi ---- - <br /> State/Zip CA <br /> Phone j 249j- 6�3_�izL�--------- - - - -- -- ------------ <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application : Use Permit , IXI <br /> zone Reclassification, [ ] Minor Subdivision , Site Approval , <br /> Zone variance, L] Oth 'r : <br /> 2 . Project location :--L4QQdbridge - West--end of..Augusta ..Street <br /> Describe the project; i . _ . , request. bt2 ing !1111 If, anti nature of use. <br /> Identify specific project components : <br /> -- ---------------------- <br /> -_--_____ (ATTACHMENT 11 <br /> 3 . Total acreage of project: 13.5 # of existing parcels 2 <br /> Assessor Parcel Cs ) :- 015-060-45-C34 — <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site, provide title and date : <br /> 5 . Other permits and approvals (cvunLy, State and Pc-6,2ral ) <br /> required for this project : <br /> PERMIT At',EN:'Y <br /> Sales _State Dept.-_o.f Real Estate <br /> )Ari r; , <br /> SAN JOAQUIN COUNTY <br /> PLANNING DEPARTMENT <br /> Planned District - 17 ( 8/86 ) <br />