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TC TOP OF WR9 EL~YATlON S, W S~IYER AND YlATER IATERALS 0.ECTROUER
O EP EDGE OF PAVEMENT ELEYATION INV INVERT (fLOWLIN~ ELE~/. ACOUSTICAL FENCE
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, IIIACKAYB[SO~1PS THE COURTYARDS AT DTJBLIN RANCH-TRACT 6964
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. ~ , ATTACHMENT 3
STATE OF CAIIFORNtA -?iFALTH ANU HUM/W SER~~ ~ CALIFORNIA OEPARit7ENT OE SOCIN. SERVICES
CONMUNI fY CARE GCENSING
FACiLITY SKETCH (Floor P[an)
Applicants are required to provide a sketch of the 1looF ptan of the home or facility and outside yatti. The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Circte the names of the rooms that wili be used by sfafflresidents/cfients/chiidren. Door and
window exits from the rooms musf be shown in case of an emergency (see Emergency Disaster ~'tan). Show r~om sizes (e.g. 8.5 x
12 . Kee close fo scale. Use the s ace below_ See back for ard sketch. t ,
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STATE OF C/LLIFORNIA • HEAIiH AND HUMAN SERVICES AGENCY CAIIFORNtA DEPARiMENT OF SOCIl~L SERVICES
• COMMUNI7Y CIUtE UCENSING
FACILITY SKETCH (Floor Plan)
Applicants are required to provide a skeich of ihe floor pian of the home or faciiity and outside yard. The Floor sketch must label rooms
such as the kifchen, bath, living room, etc. Circle the names of the rooms that wili be used by stafflresidents/clientslchildren. Door and
window exits from the rooms must be shown in case of an emergency {see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x
12 . Kee close to scale. Use the s ace below. See back for ard sketch.
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UC 999 (3199) . ~ .
~STATE OF CALIKORNtA - HEALTH AND HUMIIN S£RNICES AGENCY CALIFORNIA OEPARTAIENT OR SOCIAL SERVICES
~ . COMMUNITY CJ1RE L~CEP~S~NG ~
FACILtTY SKETCH (Yard)
The yard sketch should show all buildings in the yard inciuding the home (with no detain, garage and storage building.
tnclude walks, driveways, play area, fences, gates. Show any potentia! hazardous area such as pools, garbage storage,
animai pens, etc. Show the overali yard size. Try to keep the sizes close to scale. Use the space below.
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