SU0012999 - Laserfiche WebLink

Home Browse Search

APPLICATION - REVERSION OF ACREAGE San Joaquin County Community Development Department FILE NO: RA - - Proposed Parcels Parcel Number(s) Existing or Proposed Use of Parcel Existing Square Proposed Square Footage or Acrea e., Footage or Acreage 5q- too-o '-•" S �, �� I�5� �tE �. +��} IK-ix�5 Water . Service Provider. Annex-Formation Distance to Public Public Water Required Water Feet Existing Proposed CAI. VSIA't`�K Private Water Existin Well New Well Well Replacement Sewage Disposal Service Provider Annex-Formation Distance to Public Public Sewage Disposal Required Sewer Facili Existing �IT1� d� araC KToI� Proposed On-Site Sew. a Dis veal Existin Se tic System New Septic System Other Storm Drainage Service Provider Terminal Drainage Distance-Retention Public Storm Drainage To: Ponds Existing 5.S GotAIsTY'. .w Prposed Private Storm Drainage On-Site Retention Popd(s) Natural-Drainage/No change Other San Joaquin Area Flood Control Agency(SFAFCA Assessment District Yes ❑ No AUTHORIZATION SIGNATURES (Signatures are not required if initiated by San Joaquin County) ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZECI AGENT MAY FILE AN APPLICATION 1,the Owner/Agent, agree to defend, indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or proceeding against the Owner/Agent's project �rv�►�-ia+�� y�}-.. V�Y'c� �� I further certify, under pealty of perjury,that I arri(check one) ❑ Legal property owner(owner includes partner,trustee, grantor,or corporate officer)of the property(s) involved in this application; or '- .❑"Lega]agent(attach proof of the owner's consent to the application of the property's involved in this application and have been authorized to file on their behalf,.and that the foregoing application statements are true and correct. Print Name: 4-.. Kc�Y`&1% _ Signature: Date:-*7&2- Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: