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SANJOAQUIN <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> ROAD NAME CHANGE <br /> PRE =APPLICATION : ❑ <br /> c Applicant Information Applicant Representative Information <br /> Name : <br /> �k Name : D ,malt * 4 ;2 e <br /> Mailing Address : TY)AMailing Address : /=A Zc9 A <br /> LUZA;q do <br /> s� � � � � � �► �S �S <br /> Phone : Phone : Z o cl <br /> Email : Email : /Cn 4n , isp L4/ , Q �' <br /> Proposal <br /> (Attach additionsl sheets as necessary) <br /> X Public <br /> Public or Private Road ( check only one , separate applications <br /> required for each ) : or <br /> A& Lf rivate <br /> Existing Road Name : L -irk Sod t t� , L C� <br /> Proposed Road Name : <br /> Location of Road : J � � � 4e, � � 'ti � t , � �, o4 �= Tit � <br /> FReason for Request : � � h t ' �� G-� , 1 S . Th , S S .. a l! t,4p�.S 4*v> 6L )tte, ic{� L /3 eJ b / .L e �7 Cc LIS , <br /> Related Planning Application ( PA ) number( s ) : <br /> Is this application tied to <br /> another discretionary Yes : ❑ No : 19 <br /> application ? <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 /> APPLICANT >WRATURES <br /> Print Name : (1 0 � I nature : 1141, Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Print Name : Signature : Date : <br /> Page 1 of 1 <br /> 02/04/2022 <br />