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s <br /> COUNTY OF SAN JOAQUIN <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> FIRE SERVICES DIVISION <br /> 1810 E.HAZELTON AVE. <br /> STOCKTON,CA.95205 <br /> 209-468-3380 <br /> FIRE ACCESS ROAD DECLARATION <br /> Fire District: r(�k ?'U Cross St: PU'A P-1M 1 e'^'Y <br /> (Phone numbers on the back) <br /> Applicant's Name: ( �✓�j ��7 (is-r tu�j��-'� <br /> Address: Q(� S ' Z/ <br /> jD VS4,o✓C4'/�fTy t�/7• `�' <br /> Telephone: <br /> Owner's Name:_ <br /> Address: Telephone: <br /> Job Site Address: At A.P.N. a / <br /> Type of Structure: OO Sq.Ft. Permit Number d3W 3g Road Length <br /> Fire Road Status: _Plans Complete _Not Constructed Yet _Under Construction X Road Complete <br /> Your application for a building permit indicates that fire access may be an issue. San Joaquin County Ordinance <br /> Codes and The State of California Fire Code require that fire access must be provided. <br /> This siened form will be forwarded to the Fire District above <br /> "Requirements for Fire Access Roads"as approved by The San Joaquin County Fire Chiefs Association,are <br /> available at the Community Development Department. <br /> It is the responsibility of the owner to obtain approval from the Fire District prior to <br /> requesting a foundation inspection or utilities release for mobile homes and modular <br /> homes, from the building department. <br /> It is the responsibility of the Fire District to inform the Fire Services Division of Community <br /> Development Department if the Fire Access Road is or is not acceptable, (At any time before,or <br /> during construction and prior to occupancy). <br /> I declare that 1 have read the information on this form and understand that as the owner or authorized agent I am required to <br /> fulfill the fire access road requirements. I understand that a violation of those requirements may result in the issuance of a <br /> citation under San Joaquin County Ordinance Codes and may result in further enforcement action,as well as delays in <br /> construction progress. <br /> Owner or authorized agent: <br /> X I C Date / Y <br /> Print Name <br /> X Title <br /> -�Sign-atulT' <br /> Fire/Fire Roads/Declaration <br /> Community Development 2(08102) <br />