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HomeMy WebLinkAboutBUTTE CO. PLANNING DEPT. 79-67 1•'k� ' ,... �!�'�'+ �l of r Nd�T n�+,rv4{n}t �P Bt.s��� i ,gs tJ,fi� :.,* 11 r t `!• b ) 1 :.i S ♦� �. t W a ;ry{i q,tl XN'y,{� K YIf���T�-v�9 Kt� lan���'��t r�1��! t : _� .. 'W_ ll♦ � t �� f , ter; r �'',�v �. n iVar�ytl eva � • I � ✓t, e?< �� i Ftl 't#�M i ,�d;+t'� ' % �s a l . ,�K t�'.,• •yl 1 .♦' "� 9� a �' I � �"�- ����. • 41 � ��J tF t L t �r . d [ r fir. • h '� �I., 0 e .. t � ".•� .i L 1 wl . r r s 1 • wi 1 a � r r " A rt �� n ` , fr t n rY r� �� � rw • I +' � ��t• ' 1_•v t• r � , .•f ' �s � 1 awl, J♦q' t�'�5 Alp A M Ec Mid Valley Title & Escrow P.O. Box 3030 P.O. BdX 983 P.O. Boer lOGb ,183 E, Sixth Street 7020 C Slty� vay" 1751 Oro Dam 68 Chico, California 05926 Paradise, California `'0506 i'r�vtllir, California 05065 Phone 342-83'3 Phone 877.4171' Phone 533-6680. JACK o, BROWN Vlto•Pref+lrlant and Office Manager, All glides Of lylle h1S161Y171re y,Ss?l['C1r h WARREN BUTTON VERNE E. DRANE Ty1`Sl ��j1enc(11 71'llG' �11S111'lL11lG� G$112j111y ParadiiiQ Branch Manager Clilef Title Officer FORREST B, YOUNG � PATRICIA CASTLE grMWII,LIAM GOLLING Presider(( and County Manager Oroville Branch Manager RM Burt Lowen ORDER NO, BU ,4'3902 Calif Land Title Assn Stand ge Requested: ard Coverage policy Farm In ormf dlicy Covera response to the above referenced application for a of to isstie, or cause'tor be issued as policy of title :insurance, this.. Compaliy hereby reports that It is r prepared , 'tTie date hereof, a P0116y of Title Insurance in the for specified above, describing the land and the estate or interest lem relnafter set forth, Insuring against loss which may be sustained by reason of any defect, lien or encumbrance not shown or referred to as an Exception ((clow or not :excluded from coverage pursuant to thCorm, e. Printed Schedules, Condition and Stipulations of Said Talley ti This repot t (arid ally supplements or athendrnents thereto) is issued solely for the purpose sof facilitating the rri Issuance Of,a policy of title Insurance and no liability is assumed hereby, If it is desired M41 liability be assumed P issuance of 4, policy of title insurance, a Binder or Commitment should be requested, rior, to the l Subject to'' a cancellation charge as required by Section 12404 of the -,Insurance Code and 'Rule 2, of Department >: , of Insurance Bulletin No, NS --35E. Dated as afbecembcr 27,197$ at 7;30 a Title Officer Title of "sald estate or interest at the date hereof is Vested in, BURT C. --L&M JIB. and DOROTHY JANE LOWEN, ' husband and wife, as Community; Property The estate or Iriterest In. the land. hereinafter described or referred to coVered by this Report is, 2. A Deed of Trust to securo an indebtedness of $1.,975,000.00 recorded December 15, 1977, in Book 2239, of Official. Rocords, at page 507. IDATBD: November 28, 1977 TRUSTOR: Burt c. Lowen, Jr. ,and Dorothy Jane Lowen TRUSTEE: Central Valley Security Company,a California corporation BENEFICIARY: Sacramento Savings & Loan Association, a corporation Affects this and other property Notice of Additional,_ Advance under the above Deed of Trust in the amount of $1.30,000.00 by Sacramento Savings and Loan Association' to Burt C. Lowen.► Jr. and Dorothy Fane Lowen dated June 23, 1978, recorded June 28, 1978, in Book 2299, of Official Records, at page 3 The right to pur,p, take cr Otherwise extract water ,from beneath the herein described property, without however, the right to enter upon the herein described property, as conveyed to the 'California Nater Service company,.a California corporation, by Deed dated December 7, 1977, recordeq January 12, 1978, in Book 2247, of Official Records, at page 317: For further p ► y t• particulars, reference �s hereby made to said document. v C+7djm January 2, 1979 nESCRZPTibN: All that certain real property situate in the County of Butte, State of California, described as follows:, Lot D, as shown on that certain Map entitjed, "PEBBLEWOOD PINES SUBt)IVT$ION", Which Map was recorded in the office of the Recorder of the County of Butte, State of California, on November 15, 1977, in Book 58 of Maps, at pages 78 and 7,9`« ! j y1�+�:•..•aw.. :aae M IN I �e.11a. oG' �s l! 2G fs,rm• :Lr'osz'+s•aTw�yec�-ha�•w1vT17,71{G•p.-• �.+�<'y' �(s; 1 o � .o«r � � "' �omr "°� Ai •cus.wc/crtcacty 31+�•,C,c - -, - - %Lcr J.a - QTY .���T®la•zz•a tea. a.m• - � I • _....ao'� Lsar s' +, lei iz fso•w ,>w o � �.�SC ;+:.. 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ALIO .iaaociATi°s.iraC.. - `is ... - `cNlco GALIIroRN 1A � Z ,r w , APPENDIX F 4ENVIXONMENTAL CHECKLIST VORM,,, 7:ubQ� it completed by Lead Agency) I; BACKGROUND � o 79-01-Q5-Q. 9 1: Name of Proponent p_ .__t Bu ive 2., Address and Phone Num er o tProponent;Jr Route 1 Bo-.299 Orland Californa a 95963 c° R111e� 8 Assns motes 331 Wall Street Chico California. 559216 3. Bate of Checklist Submitted 4. Agency Recuiring'Checklist:_ 5. Name. of Proposal, if applica e APII 08-06-01 west Rexane.from PAC northChico,. to PAC on II. ENVIRONMENTAL IMPACTS r (Explanations of all "yes" arid- "maybe" answers are on 11 attached sheets,) re u red q �y!�S tfAYI3E' NO I. Earth. Will the proposal, result in signfl,cants a.,ilnstable earth conditions or in - changes s in f g geologic substructures? b. Disruptions, displacements, corn- paction or overcovering o£ the soil? c. Change-in topography or ground sures .face relief features .or removal of topsoil? el, bestru tion; covering or modifica'= tion of any unique geologic or physical features? e In^rease in :wind or water erosion Of soils ether on or off the site? �f Changes in deposition or erasion of beach sands, or changes 'n silta- tion, deposition or erosion which may modify the Channel of a river or stream or the bed of ;the ocean or any bay, inlet or lake? g: Loss of prime agriculturally,Pro- ductiva soils outside designated urban areas? Appendix F" page l of 9i '. Is MAYBE N0 h', Exposure of People or property to 90010gic hazards such as earthquake-S, , - lands .lides , mudsl;:iges,ground failure;, or similar hazards? 2. Air. Will the proposal result in, " r a.-Substantial deterioratiori(:of ambient or local air quality? b. The creation of objet-tionable odors,, smoke .or fumes? ~s c. Significant alteration of air .movement, moisture or tempaturer or any change in climate, either locally or regionally? 3. Water. Will ,the 'proposal result in substantial A. Changes in currents, or the course or diSection of water ;movements?if b. Changes in absorption rates, drainage patterns, or the rate and amount of` surface water runoff?Affik c'. Need for off--site surface drainage improvements, includin&,vegetation removal, channelization or culvert Installation? c.l. Altera-tions to the coutsp or flow %' of flood waters' e. Change in the amount of- surface water in any water body? JUL f1 Discharge into surface waters, or in any alteration of surface water quality, including but, not limited to temperature, dissolved oxygen or turbidity?, r_ Alteration of the direction or rat e of flow of ° ground waters?,, h. Change in the quantity or quality Of ground waters, either through direct additions or;:withdrawals, or through interception cif ,.an a ui�ier b .cuts _ q r y or excavations? Apendixr- Page 2ofAsk9 qP - f 1, YTS MAYBE 110 i. ;deduction in the amount of water otherwise available for public .rater supplies? J Exposure of, people or property to water related hazards such a's flooding? _.;. 4 4', Plant'; Life; Will Che proposal result In stantial: a. Lops of vegetation or change in the diversity of species or number of .any species of plarts Sincluding trees, shrubs, grass, crops, m.croflora and aquatic plants)? " } b, Reduction of the numbers of any urigie, rare or endangered species of plants? C4 Introduction of new species of 'Q' plants into an area, Or in a barrier to the normal. replenishment of ". existing species?, .!! _ .. d, Reduction in acreage of'any agri- cultural crop? : Animal ,£e. Will the proposal result 5. mL , ub s ein t i l : a, Change in the diversity of species, or numbers of any species of animalsV r'as,, land animals including reptiles, fish and shell- fish, benthic organisms, insects or micro f aura) ? b. Reduction of the numbers of any unique, rare or endangered species cif animals? c. Introductionof new species of animals into an area, or result in a barrier to the mi.gratio'n or movement of animals? d, l Reduction of encroachment upon, or deterioration to existing fish: or wildlife habitat? -� Appendix F - page.3 of 9 YES MAYBE NO 6. Noise. Will the proposal result in, aubs'tantial a. Increases in noise levels? „ b... Exposure of people to severe noise J levels? 7. Light and Clare. Will the proposal produce sign icant light or glare? 8, '-Land Use. Will the proposed 'result' in a significant; A , Alteration of the planned land use of anarea; or establish a trend which.ldemonstrably lead to such alteration?° t-,. Conflict with useson adjoining properties, or conflict with estab lished" recreationalL, eduta- tional., religious or scientific uses of an area? 9. Natural Resources. Will the proposal result in substantial a, Demand for, or increase in the rate of use of any natural esources? b. Depletion of any, nonrenewable. natural resource? 10, Risk of U2set. IIoes the proposal n or involve a risk o fan explosion los o the°release of,hazardous substances (including, but not limited to oil, vest cides, chemicals or radiation) in the event of an accident or 'upr>et Alk conditions? 11, Population, Will the proposal significantly alter the location, distribution, density, or growth i ute of the human population of . an . area or physically divide an established community,? 12, Hous in,. Will the proposal signi scantly affect ex"--4 ng housirg, for or create a ;,demand additional ° housing? . i . _r.:e .°.. mer��vti'�Llitttta�w®RMri�YA Appendix:F Pages 4, of 9 i� i - YESMAYBE NO" ,: , ' Trans ortaIion%Circ tl ' t'on.. Will thio,, proposal re.s�ult in, a. Generation 1of substantial. additional movement? ' ON) vehicular` a�° b effects on _existing y Signifit'.'ant arking facilities, or demand for new parking? C . Substantial impact upon existing transportation systems? d. Si'gnifcan alterations to present i.. patterns of circulation or movement of ,people and/or goods? e, Alterations to. ',waterborne, rail or air traffic? f , increase in traffic hazards to motor vehicles, bicyclists or p.edestri:ans?►' 14. Public. %eryices , tiJl1 Ghe proposal Have an eft upon, or result in a substantial need 'or new or altered governmental services in any of the following areas; AM - a. Fire protection? b Police protection? Schools?' = c. d Parks or ether recreational Ask ililities , ;1 e Maintenance of`public. facil Cies including roads? f'. Other governmental services? 15. Ener Will the proposal result'in: gY_ � p p a. Use of 9ubst9fttia1 amountsLof fuel �. o n r energy? _ , b. Substantial increase in demand upon existing sources of energy, or require the development of new sources of energy? 16, Utilities. Will the pr0po8a'1 result in a need�for new systems, or; sub- statital alterations to the following utilities :, l ,Appendix V page 5, of � it If YLSMAMA NO I �4°('Staining` Levels; threaten to nati:,, a plant or anitrtal com- i�,,.dinity, x"educe the number of restrict-_ the range of a rare or endangered plant or animal or eliminate important examples of the major periods of California history or prehistory? b. Does the project have the potential to achieve short term benefits to the detriment of publicly adopted AM long-term environmental goals? C. Does 'the project have impacts which are individually limited,•but (a cumulatively considerable? project _ may impact on two or more separate resources where the impact on each _ is relatively small, but, resource where the effect of the total of those impacts on the environment is significant.) d. Does the project have environmental effects which will cause substantial adverse effects on human, beings, either directly or indirectly? 9 it r A endix pp. r -pale 7 0 III. DISCUSSION OFENVIRONMENTAL EVALUATION This project is a rezone from PAC to PAC on AP# 08-06-Q1, northwest Chico. The 1.08 acre site is located at the southeast corner of Cussick Avenue and the Holly Avenue intersection. Pebblewood Pines PAC, "Lot D" is phase two of.-a PAC proposal by. Burt Lowen Jr. Phase one of the 'PAC was approved by the Board of Supervisors on June '28, 1977; the tentative subdivision map for phase one was approved,by the Advisory Agency,on duly 11, 1977. Phase one which consists of 44 dwelling units with common open space, parking areas, landscaping: and swimming pool is totally complete,. ' Lot D is presently cleared of most -vegetation other than some weeds and grasses, s/he topography is fairly level. Soils are generally Vina fine san�y loam on the site. Lindo Channel lies just south of the subject property. The drainage channel is empty at present and consists of tones with no vegetation in the channel bed. The surrounding land uses include orchards to the east and west, phase one of the M to the north, and a residence to the south. The,Butte 'County General Plan designates this area as medium low density resi- dential,, _ S to 8, dwelling, units per acre. The City_ of Chico General Plan indicates E -his area as agricultural on the Land Use Map, 1(b), 3(b), 16(e): The capability of the site to absorb starmwater will be reduced because of the construction of impervious surfaces in the form or roads, parking areas,. sidewalks and buildings. When. the project is complete, approximately one-half of the site 'gill be cover'- ed Surface runoff will be increased accordingly, and this added drainage must be accommodated. This project would Utilize the Cussick Avenue Storm Drain. 1(h): County-wide studies done in connection with the Safety and Seismic Safety elements of the General Plan indicate the following, degree'of Hazard related to soils and geology at this location: expansive soils: low hazard- subsidence moderate hazard; lique- faction potential: moderate`haprard. (Note: Much of Western Bute County is rated "moderate" as tl&bs'ubsidence and lique£aCtion potential.) 3(f): Some degradation of surface water quality is anticipated from lawn fertilizers, pesticides, crankcase drippings, etc. This effect ,is not expected to be significant when only the present project is con- sidered;this is .a cumulative problem to which each large development contributes a share, 3(k): While storm water absorption will be reduced, some water will be passed into the soil from; the septic tanks through leach fields., Appendix F.. page 8 of 9 This discharge is not expected to 'adversely affect the quality of groundwaters used for domestic consumption. 4(c) Landscaping for the development is planned and may result in, the introduction of plant species not naturally occurring at this location. This is not anticipated to be a significant adverse environ- mental effect. 6(a): Some increases in noise levels associated initially with con- struction activity and later with traffic increases and human residen- tial activities. This impact is not significant. 8 The proposed 'use conforms to the county General. Plan (which cur- rently has jurisdiction) but does no,,t conform to the City o£ Chico General Plan, which indicated this as.:,,an agricultural area. ll, 14(c):' The 6 units proposed are egpected to house an anticipated maximum of approximately 16 people, Of these, approximately 6 may be school age children. 13(a) About 42 vehicular trips would be added to the daily traffic.-,. counts- in the vicinity.!` 13(f): Some hzard to the pedestrian public (particularly school children) will 'occur unless sidewalks are provided. Mitigation: pro- vide sidewalks as required by the Butte County Public Works Department. Sidewalks may not be installed along Cussick Avenue. Public iforks recently received a letter from the Chico unified School, District.con- frming that sidewalks along Cuss_ick.Avenue would not be necessary but that the Holly Avenue frontage should include ;sidewalks. '1 <t 15(a)':,Substantial amounts of fuel and energy will be needed io heat and ai�^,condition the proposed buildings; although not more than would be required for 6 individual single family residences in a conventional subdivision. Possible mitigation: heavy duty insulation, thermal - paned windows, restricted Plow showerhe'ads, pilotless gas appliances,. ;,high efficiency heating and cooling,,, units The project. proponent has considered energy conservation and }gas incorporated a number of ener, saving features into the project design, including circulating hot water and special toilets which use less water. 16 (c) ::` dater lines have been provided to phase one of the PAC. The development of phase" two of the PAC will require ~meeting the 'require- ments ,of require-ments,of the California Water Service Company for obtaining domestic _ water. Appendix F - page 8a of 9 o `LAND SOF NATURAL WEALTH AND BEAUTY DEPARTMENT OF PUBLIC WORK'S CLAY CASTLE<3ERRY, Director 7 COUNTY CENTER DRIVE, OROWLLE, ckwoRNIA95965 Telophone!(916) 534.4601 H. W, McO,ONALO {rentor January, 29, 1:979 Daauty D„ Mr. Burt C Lowen RB: Pebblewood Pines PA -C Ii,C Rt. 1 Dox 299 Lot D" Subdivision ttr Orland, CA 95963 Dear Mr. ;Gowen: At the regular meeting of the Butte County:, Subdivision Committee held January 24, 1979, the Committt&e'reviewed the above -identified PA -0 subdivi,ion and will be recommending the following conditions to the Planning Commission: it Submit road and drainage plans to the Department of Public Works fog approval and install. the required facilities. 2: Provide 20 -ft. radius Property lane returns at all street intersections. `')3. Provide right -of -xray for standard go. S-5 at a1.1 stxeet intersections. 4 Indicate ,a 50 -ft. building setback line from the centerline of Cussick Avenue and 55 -ft rbuilding setback line from the, centerline of I3ol,l.y Avenue; 5. Construct remainder of street section on Holly Avenue to RS -2 A road standard with vertical curb; gutters anal side 'walk and 2'r AC, gee AB, �SC 25G prime and fog seal; Construct one half I street section on Cussick Avenue to RS -2 B access road standard wittt vertical,_curb> gutter and sidewalk. Minimum struetura section to` be 2" AC and 811 AB with fog; seal and 95% relative compaction. Submit design to Count ,f Department Of Public Works for appr6val. "H11 value detex- minations and other data may be required to support section desa.grk. l , �6. P rovide tnonumentation as required. by'the Department of , l?ublic'.`t�rorks in accordance with accepted. standards. I � ,y. �.. w�sm i1.IlA ,.':., r_�I �.o,."' '......�r.r`un•v�I® Mrd. Burt zo`Wen Rk; Peb�,jewood Pines PA -C "Lot D" Subdivision January 29, 1979 Page 2 rc ; 7. Street grades and other featured shall comply with the !3?z,Ute. County Ordinances, design resolution .and other accepted engineering. standards. 8. Provide permanent solution for draizageh 9. 113. easements of record to be showrir on the final rnap,. 10. Meet requiremeres t ,bvette County Fire Department rr other res- tonsible agency. ll. Street lighting shall be provided in accordance with Butte "Oounty << f� requirements accepted design criteria and recommendations of PG&l;. 12. Segregate or pay, off assessments. 13. Meet requirements of Pacific Telephone Company and P.,.&B. 1. 14. Meet requirements of California Wl,�i ter. Service Company. 15. Obtain clearance from the California Regional, Water Quality Control Board. 16. Provide dootunentation from the California Water Service Company that it is willing and ;able to supply domestic water to the development. The Health Department comments with respect to applicant's request to utilize tete feet of the road setback for leaching purposes. Their department will not object to the request provided; a Future replacement lines are installed at the time of the original sewage disposal installation and are blocked at the distribation box for future use, b The developer locates as many leach lines as possible out of the ten (10) feet area. The Planning Department will notify you of the date, time and place, that the Planning 'CGmmi.ssion Y� l�l be reviewing this project. If you have any questions regarding this matter, please contact this office. Vc,rY trulyyours, C1ay.Castleberry I Director,, of Public }larks r' Cr :F John N(egdonua JM%tev Assi:sti ht Director '� i) APPENDIX G NEGATIVE DECLARATION REGARDING ENVIRONMENTAL Ii' PACT �' 1. NOTICE IS HEREBY GIVEN that the project described below has been reviewed, Pursuant to the provisions of tho California Environmental` Quality Act of 1:970 (Public Resources Code 2'I'IOO) et a.) and a detormin.ation has been made that it will not have a significant effoct -upon the environment. 2. DESCRIPTION OF PROJECT: Log / 79-01-05-01 Rezone from PAC to PAC cin AP#" 08-0 -01, northwest Chico. . LOCATION bP PROJECT; The southeast corner of,Cussick AvenYue and Holly Avenue intersection, northwest Chico. 4- NAME AND ADDRESS OF PROJECT APPLICANT: Burt C. Lowen, Jr Route 1, Box 299 Orlando California 95963 5• MITIGATION MEASURES F. A cop of the Environmental Review Director'"s initial. study regarding the environmental effect of this project is attached. This study was Adopted as presented. Adopted with changes. Specifl c modifications and supporting reasons are attached. 7. p ,{ A public hearing on this Negative Declaration=•was held by the decision making body. Hearin body _ Hearing Butte Count Board of Su ervisors Date of Determination Determination; On the basis of the �n.vi�,wonmentai Director's initial study, the information presented at hearings, comments received on the Proposal and our own knowledge and independent research, Ap�.;endx (x - page 1 of 2 W APS C8-0�7�0'I 73uri; C. Lowen Jr. estate Cleaxi c ' .tz=e, N!1m1` Y s, ,1 Ie , one Number i � „�,!,�� Lars D. i� � i.�o7�, 1�.►.x�7t; t.ar, , Project Lavation -- he southeast corner o.f Ot�es�..a.��k venue N011� Avenue `iixborsr eat on northwest _ Chico Project~ llescrptaon oniativo Subdivision Map �. N cD Or DETERMINATION TO, /�7 Secretary for Resources 1979 1416 Ninth Street, Room 1..311 Sacramentot' CA 95,814 1C'A. NN, County Clark _. DaoufY /57c County Clerk liij,f t County o' 1�ROr1 a (bead A ency) tf:7�virGrn�l...sa`t;a. Reviewep'LT aiErn"ent fir t rarJ�LU�arl;0 Conner Drive lC��lorria g57.6 51JI3.7E6'r Filing of lVotice of Def�;erminatrion in Compliance with Section 21108 or 21152 of the, Public Resources Code, li ERD Log # X19 (-,05-01 , Pro 7 ec t Title �'o native Subd.ildsion �� APS C8-0�7�0'I 73uri; C. Lowen Jr. estate Cleaxi c ' .tz=e, N!1m1` Y (submitted to State C earinc, House ontact PPx seenc. , one Number i � „�,!,�� Lars D. i� � i.�o7�, 1�.►.x�7t; t.ar, , Project Lavation -- he southeast corner o.f Ot�es�..a.��k venue N011� Avenue `iixborsr eat on northwest _ Chico Project~ llescrptaon oniativo Subdivision Map �. __. f --------------- i tzLt,� Go��a 4,r Advi 8ory AgencS This is to advise that the- Ledrl Agency has made the f ollowing determinations regarding the above-des6, ibed project; willhave sis nificac z�ffect on the 1, Tile pro j ec t 7r will not environment. 21. An Envii:onmental Impact l,Opor t was prapared for this proj ect' pu7� to,the provisions of CCQA, 4nd was certified as required by Section 15085(g) , 1/California Administrative i Code' A t�e'8ative Declaration was. prepared for; this project pursuant to the provisions of CEQA. A COP;' othe NeBati ve Declaxa- Lon y the Envi:°ronmcntal Review Department, 7County` Center Drive, Oro'ville, California 9$965. 3. l -T A Notice of rXemption was filed indicating; this project is e:x,etmpt from ervixonmental. revIP-W. Appendix li - page 1 of., 2 AM �IAZLVER nPFL CATION PPX-L2:J' WJ"14ZY iSUBDIVISICU (Please checrk appropriate box) !?JBLIC PMARING DATE AP -,ZIA ICANT: UA--r Cl- 6LO' ZHOZZ NO: cat ;o..-s.I-i., I5'CJTxCE 02 HL;,-.RTW 1O: �'L£, 4:��� �c,119 S-� ii .'°�".�, � ,� � �'�" t -� �S s c � s.�.. +•tea b� , .; IaCC:yTIQt�T: TG rivS:il!� ��GE SLCTIOV _ ZONING oi4 VAS s VOL,. j).-:MD ��'E+�i� C- : ia. a SJB.iT�` l ^" I.i iT,� :3` T:i:T:ta Rk; a--tT CiR ;.-�CZ1t cLI:C:Y OF T .T,zZ .t�`,'SU'AZTC ' s"Y DLaT", ts+1�71J W� :-LvG JLVC '.�.sZT.r Vii IL D BY t?. UCH H S � T.T UPRB .l. t� . h 7 T �y'ITri YOUR??ia.G:S%'lUil. ✓:syr: k'r 11.11 „�1''��.�Ci/L �� 1 ��'1�.�. CD t r r :=L'S B?:.titiG Ck7i, ,"��A' (:including any romai nder) LG ii'TSTA vC�, o =tj i4.A .' /:2 COURa, CulSTM11.1 PGp'OS= 1'aq' iiG 7 ur SLI: (Check W11th Health Zc-partir,ent) :ZOOS%;D SCiiitC Gv 11ctiT:.;rz (Check viith 'HealI D�Fq@y tment) i om, BOUITD;;p'.. W. ma: O? IG:Cst.ays, kms.-s'. C;s1:_ T✓rr:, 1)IS,th:..i, TI-,::.Y C°.'ir'r' ruyV'.. tCl $i� r,H , • ` eIPCi7Ti1Gi��ic�� j;�vTnr" �;C3c��. r