Address Request Form - Stanislaus County Department Of Planning & Community Development
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1Department of Planning and Community Development
Building Permits Division
th
1010 10
Street, Suite 3400
Modesto, CA 95354
Phone: 209.525.6557
Fax: 209.525.7759
Address Request Form
APN (Assessor’s Parcel Number) _______ - ________ - ________
Date: ____________________
Road Name _______________________________
Nearest Cross Street ________________________
Owner Name ___________________________________
Applicant Name __________________________________
Mailing Address _________________________________
Mailing Address __________________________________
City, State ___________________ Zip______________
City, State _______________________ Zip ____________
Phone (____)____________ Fax (____)_____________
Phone (____)_____________ Fax (___)_______________
Email Address
Email Address
Name of Current Occupant or Tenant (i.e. Business Name): ____________________________________________________
Is there a permit associated with your request? No
Yes Permit Number: _______________________
New Address
Address Change
Additional Address
Other
Please explain in detail reason for request: Vague or unclear explanations may cause delay or denial of address.
_______
____________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Additional pages may be added if necessary
Please attach the following documents:
1) Grant Deed
2) Assessor’s Records
3) Any other documents (i.e. request from Utility Company/Post Office, etc.) to support your address request
4) A complete single line drawn site plan, not an aerial photo, on a minimum 8 ½ X 11 showing the following items:
a) Show Entire Parcel with all Dimensions
b) Easements
c) The Direction North
d) All Setbacks from: Property Lines, Existing Structures, Pools, Etc.
e) All Driveway Locations and Width
Drawing does not have to be professionally done and can be hand drawn but MUST be clear and legible
Return the completed information to:
Stanislaus County
Department of Planning & Community Development
Attention: Addressing
th
1010 10
Street, Suite 3400
Modesto, CA 95354
Please note incomplete submittals may cause delay or denial of address issuance. Additional documents or
information may be required.
This Area is for Official Use Only: Received By: _______________
Date Received: ____________
STRIVING TO BE THE BEST COUNTY IN AMERICA
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