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� Q N COMMUNITY DEVEWPMENT DEPARTMENT <br /> SANJCOUNTY SITE APPROVAL/USE PERMIT <br /> ;.`, rerr[ncss gr�:vs 210095 <br /> hcre. PA <br /> FILE NUMBER: <br /> PRE-APPLICATION: ❑ <br /> Owner Information Applicant Information <br /> Name: Name: �. 4.: <br /> Mailing Address: Mailing Address: <br /> Phone: L201t ?(ie 19 Phone: Zcq S9 ,2,-j`j�- <br /> Email: m-)rf [�G riJ�Y Lp Email: ttCty On <br /> Applicant's Representative Information j Design Professional Information <br /> Name: 'rte"`/ Z' v--yName: t •, lINIC. <br /> Mailing Address: b • vx �-� � ) Mailing Address: F.©, (Olt <br /> 1—DA I r CA gs?Al <br /> Phone: G — Phone: 2CR 334- <br /> 2 12- <br /> Email TC)D\ e-cy N Ls 411 e4 --A I . SNL Email: i �; <br /> Project Description <br /> (Attach additional sheets as necessary) <br /> Site Approval <br /> Type of application(check only one,separate applications or <br /> required for each): <br /> ❑ Use Permit <br /> Project Summary: AC-Aa stvy- pd � tt.�t % cf�. <br /> � McC Aeatu <br /> en v o F - Vol- d <br /> I t, t . <br /> Will the project include more than one(1)phase?(maximum of 2 phases)Yes: ❑ No: <br /> Length of time(maximum of 5 years): <br /> Note:For questions regarding phasing,contact the Planning Division at 209-468-3129. <br /> Related Planning Application(PA)number(s): <br /> Is this application tied to another <br /> discretionary application? Yes: ❑ No: <br /> Property.Information <br /> Assessor Parcel Number Property Address Property Size Williamson Act Contract <br /> ©A - Plo "�} � 6 SfA- t- 2 of ,6k- j + 14G Yes: E] No: <br /> Yes: ❑ No: ❑ <br /> Yes: ❑ No: ❑ <br /> Page 1 of 6 <br /> 08/1312021 <br />