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APPLICATI6N Applicant's Name 1`1✓ w ^��- Assessor's Parcel No. <br /> for p Contractor p Authorized lkyent book �/7 <br /> APPROVAL. Address 3 h/y ,�_wailpaw— �� <br /> for City LQ Diparcel <br /> CONSTRUCTION owners Name Subd. <br /> in Address unit a <br /> San Joaquin County C ty phone block a <br /> Precise location of property` f , fin lot a <br /> Yes No <br /> C3 C, <br /> Structure address A :2ICA A4 <br /> sewerwater s system p p <br /> Proposed use of structure(s) drainage system <br /> DRAW (e)Location of minimum sewage disposal area for septic tank and leach linea <br /> (a)The lot or parcel involved,showing shape&dimensions (f)Irrigation or drainages ditches,waterways and drainage ponding uses <br /> (b)Abutting streets and other right-of-way and/or easements (g)Location of existing and proposed driveways and encroachments <br /> (c)The locations of all existing building and distances to lot lines (h)Levees,with the crown shown <br /> (d)The locations of existing and proposed septic tanks and wells (1)WITH DOTTED LINES,THE PROPOSED STRUCTURE or ADDITION <br /> j. NL ortha <br /> r; <br /> aL <br /> i <br /> , r <br /> I <br /> r <br /> ; T <br /> . ._ <br /> i <br /> I I I: <br /> T <br /> II <br /> _ <br /> : <br /> , <br /> �- <br /> .,_..y_. •.-i , + :.._ _.:4, <br /> i <br /> tt <br /> IT <br /> � I <br /> I <br /> t-+ - -I -L <br /> _ + 8ade1— <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and that all existing gtructures on the property are <br /> shorn an the above plot pt <br /> n. / <br /> Date <br /> •PLANNING DIV. 1810 E.Hazelton Avenue •PUBLIC WORKS DEPT. 1810 E.Hazelton Ave. •LOCAL HEALTH DISTRI <br /> .Prof—perty meets zoning requirements for both 1.PROPOSAL Al-MOVIE-0 SUBJEC��TO�� ENVIRONMENTAL HEALTH DIVISION <br /> use and construction A. Encroachment Permit requifedED a{ 1601 E.Hazelton Avenue <br /> Yes pf No =) Zone 'Lw B. Surface drainage established as shown p 1.PROPOSAL APPROVED SUBJECT TO: <br /> 2.SPECIAL CONITIONS C. Fees A.Obtaining sanitation permit <br /> A,School district fee p a. Connection Fee p B.Obtain well/pump permit <br /> B.Floodway as shown p b. Buy -tee p C.Change noted <br /> C.Flood fringe p 2.REMARKS ' e .2.PROPOSAL DENIED p <br /> D.Noise impact p C 3.RE KS /!M ` r`r <br /> 3.PARCEL MAP N . date - -'R by / - <br /> 4.REMARKS i r r J( <br /> date�4 by <br /> > y:_.,_.• __FLOOD CONTROL daU <br /> date l' by ?i r tr. by 0 eLoa.INSP. rs te/s <br /> L9/ <br />