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i <br /> iWHO MAY APPLY ? qP <br /> ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKE OUT BUILDING PERMITS. <br /> Owner-Builder must submit the following with the application: Contractor must submit the following with the application: <br /> • A property tax statement or a recorded deed. • Current license numbers. <br /> • A completed and signed"Owner-Builder Verification"form. • A completed"Authorized to Sign"form if other than the <br /> • A completed"Authorization for Application"form if other than contractor applies(this is not necessary if this Information is <br /> the owner applies. I already on file with the Department). <br /> THIS PAGE TO BE FILLED OUT BY DEVELOPMENT SERVICES STAFF <br /> I ' / PROPERTY INFORMATION <br /> l <br /> Job-Site Address: "l 1 1 Q S )2 AP N: - Y L- b I <br /> Cross-Street: Ci : ZIP: <br /> Precise Location: <br /> (�b ' p D Ix V �c� a n c, 2-00v, <br /> Subdivision Name: — /�/7"S Ma BI/Lot# <br /> Zoning and Setbacks Zone: 'L/ Front: 3 U Left: 3Ri ht: 3 Rear: 3 Hei ht: <br /> School Districta istrict: <br /> Sewer District: Water District: <br /> Approved Use: <br /> SPECIAL AREAS <br /> Subsidence a:Yes: ❑ No: v2 Expansive Soil Area: Yes: No: ❑ <br /> Fire Haze d Area:Yes No: Ai rt Zone: Yes: No: ❑ <br /> Planni No: SJAFCA: Yes: ❑ No:I AO <br /> COMMENTS <br /> DO- <br /> J <br /> This approval ex' to that Which is <br /> escribed hereon, but does not <br /> sown and <br /> omission or deviation of requirements o <br /> WORKS DEPARTMENT, County of San Joaquin. <br /> � D <br /> Plan Check Onl YES Filen <br /> Technician: A10 Date: <br /> F:0MWVAWdR fffflRTAM-RWO"",OKFMI1u(R.nwe)owa¢) Page 2 of 2 <br />