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SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO.: SD-C'(4 - <br /> »>:<:;<:;»:::::<:::::: >.. �....0...f' '� .. APP .. .:.�............:•::: .................... � <br /> Owner.Information Applicant Information W <br /> Name: '-� _ '/ <br /> 4�c%�r 7e ,Ceo.�e vi¢�.)ee ucve.J Name: eW .Leo le �.v.1ee w4c.,, <br /> Q (j�Q�] Address: 01�d ,f fj/L(i �� Address: Q L <br /> C1 Pc�,�j� <br /> �j�• p a <br /> Phone: — 3�'l'(� Phone: <br /> .::.::::.::......:.:.:.:..... .:.:....: <br /> Y:.Y::>..)):.;::..•;;:Y:.:<.Y.;:..:...::.. .:>:::;;;;:::::::).;.;::::. Cf. CT..09SC <br /> li <br /> Description of the proposed project: 1✓41'4L L IA,, f e tai A% •e— <br /> i % <br /> �xldlof Pa/ IA.'19'9'.,2__ !/:vllec c/iFFP.��u,T- o c,u;u-ele r <br /> Occupant(s) - Name: Age: <br /> Name: Age: <br /> Square Footage of Second Unit Dwelling: 17 <br /> Year Mobilehome constructed (if applicable): <br /> :.. ;p <br /> f�4;tftClNITYMCI, 0. �E <br /> aft# <br /> :........ ? ....... :::..:.. <br /> <: <br /> .:.: r.P�hty 1ltfosinatio <br /> Assessor Parcel Number(s) Property Size Williamson Act <br /> Contract <br /> D 3- /oa - —S ❑Yes ,k'No <br /> Property Address: d y L�/ �,�_ �"�-e P N Ts <br /> ::.;.. <br /> On-Site Uses (Include Ag Crops): <br /> >:, `X <br /> Amp <br /> I" <br /> N'CS..AN� alb <br /> W. :::::. . ...Y:.Y:::.::.,:.::::.Y•:...;;;;; <br /> M. <br /> Service Provider Annex-Formation Distance to Public <br /> Public Water❑ Required Water(Feet) <br /> Private Water❑ Existing Well, New Well ❑ Well Replacement ❑ <br /> Public Sewage Service Provider Annex-Formation Distance to Public <br /> Disposal❑ Required Sewer Facility <br /> On-site Sewage Existing Septic System New Septic System ❑ Other ❑ <br /> Disposal❑ <br /> x. <br /> BtOtnt UI Y1t18 <br /> Public Storm Service Provider(ff Public) Annex-Formation Terminal Drainage Detention <br /> Drainage❑ Required to: Retention Ponds <br /> Private Storm On-site Retention Pond(s) ❑ Natural Drainage/No Change Other ❑ <br /> Drainage❑ <br /> >frltfS <br /> in .H <br /> DiiiY�i°i i`i%`5?i #333` `!i2vi `i "i`> Zik'c> i,>:#`33?'i>>#i > i <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> Gv ) y / Yes❑ Nox Yes❑ Nok <br /> Yes❑ No❑ Yes❑ No❑ <br /> -2- <br />