l�Cityof
j�SantaRosa.
- N.ANNING&ICC1N0Ml0
. , bllWl,,CJPl\.'ll!NT
DISCLOSURE FORM
ProJect Tltle: Bunya Bunya Tree Removal, 1080 Second Street, Santa Rosa 95404 (Include site address)
Please provide the name of each Individual, partnership, corporation, LLC. or trust who has an Interest In the proposed land use action. Include the names of all applicants, developers. property owners, and each person or entttythat holds an option on the property.
lndlvlduals: Identify all lndlvlduals
Partnerships:
Corporations:
Identify all general and llmlted partners
Identify all shareholders owning 10% or more of the stock and all officers and directors (unless the corporation Is llsted on any maJor stock exchange, In which case only the Identity of the exchange must be listed.
LLCS: Identify all members, managers, partners, officers and directors.
Trusts: Identify all trustees and beneficiaries.
Option Holders: Identify all holders of options on the real property.
Full Name: Addreaa:
100%Shareholder: !I,,.., 1
The SalvatiQn Army Residences, Inc. 30840 Hawthorne Boulevard, Rancho Palos Verdes, CA 90275 ... ---,----. !' ,11'
ln addition, please Identify the name of each civil engineer, architect, and consultant for the project.
Full Name: Addr111:
Chip Sandborn Sandborn Tree Service, Inc., 119 Morris Street, Sebastopol, CA 95472 .
.
Additional names and addresses attached: □ Yes IJ No
,.
The above Information shall be promptly updated by the applicant to reflect any change that occurs prior to final action.
J���� June30,2023 I certify that the above Information la true and correct:_· __________ _ Applicant Susan Lawrence Executive Director Date
I I. I
Attachment 1