APPLICATION FOR REASONABLE ACCOMMODATION
CITY OF PLEASANT HILL 100 Gregory Lane
Pleasant Hill, CA 94523
Phone (925) 671-5209
www.ci.pleasant-hill.ca.us Fax (925) 682-9327
I. General Data
406 Kahrs Ave Pleasant Hill CA 94523
A. Address of Property
B. Assessor's Parcel Number(s)
C. Zoning
Residence
D. Existing Use
E. Description of Proposed Reasonable Accommodation Request Waive all setback requirements per Fair Housing Act, Section 504, and Americas with disabilities act (ADA).
F. Proposed Timeframe for Removal of the Accommodation As long as the need is required.
As long as access into and out of the property is not interfered with or obstructed by adjoining neighbors.
11. AUTHORIZATION
In signing this application, I, as owner and/or as applicant, represent to have full legal capacity to, and hereby do authorize the filing of this application. If this application has not been signed by the property owner, attached is separate documentation of full legal authority to file this application. I agree to be bound by the conditions of approval of this application, subject only to the right to object at the hearing or during the appeal period. I further certify that the information and exhibits submitted are true and correct.
A. Property Owner
Name Mariam Azamey or James Unger Phone
Address 406 Kahrs Ave Fax
Pleasant Hill CA 94523 Email
Signature Date 3/2/22
B. Applicant other than Property Owner
Name Phone
Address Fax
Email
Signature Date
C. Authorized Agent
Company Contact/Title_
Address Phone/Fax
Email
Signature Date
TO BE COMPLETED BY STAFF
APPLICATION TITLE APPLICATION NUMBER
AZAMBU KA PUN21-04971
philled MASTFRS & FORMS FRON COUNTER FORMS PLANNING FORMS 300: Front Counter Application Ferms: Word DocumentsiReasAccomForm.doc
CITY OF PLEASANT HILL
TEL (925) 671-5209 100 Gregory Lane
FAX (925) 682-9327 www.ci.pleasant-hill.ca.us Pleasant Hill, CA 94523
REASONABLE ACCOMMODATION ANALYSIS
Application Submittal
Please provide the information requested below. Insufficient information may result in processing delays. If you need additional space to respond, please feel free to attach supplemental information.
1. Identify and describe the disability which is the basis for the request for accommodation.
Include (as an attachment) a current, written medical certification (by a licensed physician) describing the disability and any limitations on the occupant's physical or mental condition resulting from the disability.
Analysis:
See medical certificate
2. State the rule, policy, practice and/or procedure of the city for which the request for accommodation is being made, including any specific zoning code regulation from which reasonable accommodation is being requested.
Analysis:
PHMC section 18.20.050 (A)(3), (G)-Setback requirements.
Fence: 18.20.040 zoning ordinance.
1 3. Explain why the accommodation is reasonable and necessary for the needs of the disabled person(s) occupying the building. Where appropriate, include a summary of any potential means and alternatives considered in evaluating the need for the accommodation.
Analysis: To preserve the privacy of the individual all facts pertaining to this question have been provided to city staff for review.
In regards to fence: Due to security reasons.
4. Explain the measures that will be taken to reduce any impacts on surrounding property owners that may result from the requested accommodations.
Analysis: Irrelevant. Pleasant Hill City Ordinance 18.112.040 Application requirements.
Reduced impact to surrounding neighbors are irrelevant and should not be considered.
Titles Il and Ill of the ADA requires public entities to make reasonable modifications to policies, practices, or procedures to avoid discrimination.
Mariam Azamey and James Unger
Analysis completed by:
3/2/22
Iphilled MASTERS & FORMSUFRONT COUNTER FORMSPLANNING FORMS 2007Niront Counter Application FormslWord Documents\ReasAccomAnalvsis.doc
2