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'AN, OA Q U I N COMMUNITY DEVELOPMENT DEPARTMENT' <br /> -COUNTY-------- SITE APPROVALIU E PERMIT <br /> '`,. 'v'rca trs _s grpu�5 Frere. 2 ® ® 2 5 4 <br /> FILE ISI. R: <br /> PRE-APPLICATION: ❑ <br /> _1_Ownet,Information Applicant Information <br /> Name 1r1 �� . 1f t_9 <br /> Mailing Address; (� Lt_ fj �p Mailing Address: L4 tp <br /> Phone; 3—Q e,N QN k­. Phone: " >wj L C� t, <br /> Emall:. i,cx,-\A-ea 2' xs-LztVl <br /> CA— <br /> Applicant's <br /> Representative Information Design Professional Information <br /> Name; j-_L� 0 y"xnl fl*i Name; L la •K <br /> Mailing Address: <br /> -I Mailing Address <br /> Phone: tA -z—t5 1` 1-1 Phone; <br /> Email: a (�-G�. (1 1 fwfnail: <br /> Project Description <br /> (Attach additional sheets as necessary) <br /> ❑ <br /> Site Approval <br /> Type of application(check only one, separate applications or <br /> required for each): <br /> Use Permit <br /> Project Summary cn S C� +d -- a i �'r. c�� ,1 �.i� C=- c�_k <br /> j7 1 -'��t'`� '���� tai�•t��d1't �t`Ls=�v�✓� ���ac� e1 '��' ,� ,. <br /> Will the project Include more than one(1)phase?(maximum of2phases)Yes; No; ❑ _ <br /> Note:Por quostions regarding phasing,contart the Planning DIvislofn at 209-468-3121. <br /> Related Planning Application(PA)number(s): <br /> Is this application tied to another Yes; <br /> discretionary application? ❑ N0' <br /> Property lnformatlori <br /> Assessor Parcel Number Property Address Property Size Williamson Act Contract <br /> 3^ D b -- {vo "'o Q rf t t1c�+ (b ck e-- . Yes: ❑ No: ❑ <br /> Yes: ❑_ No: ❑ <br /> Yes: [] No: ❑ <br /> Page 1 of 6 <br /> 00!13/2021 <br />