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Yes No <br /> Structure address sewers <br /> / <br /> Proposed use of strAture(s) �� j/ I water system <br /> drainage system_ <br /> , <br /> DRAW (e) Location ofminimum sewage disposal area for septic tank and leach lines <br /> (a) The lot or parcel involved, showing shape &dimensions (f) Irrigation or drainages ditches, waterways and drainage ponding areas <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 ( vthpt`crown shown <br /> (d) The locations of existing and proposed sept` Ranks and wells `ti <br /> U _, RIP <br /> D LINE THE PROPOSED S-fk&C R or ADDITION <br /> T ( � <br /> ¢ _ <br /> North <br /> -.- 1 <br /> _. <br /> m <br /> I <br /> .�....._...._-�.-.. .,k._. ,. - <br /> T7 <br /> 77:�7_ <br /> _...rt .. <br /> Y J.-J,< <br /> : t <br /> ... 1 <br /> e <br /> 3 <br /> 5 <br /> € F i <br /> y <br /> 7 7 <br /> i <br /> 41 <br /> _... <br /> _w w <br /> ... 7 <br /> r <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and that all exlstAs 4 tNre's.thtL__A� <br /> shown on the above plot plan. prvp�ft�'are <br /> Date_ ( i-7 Applicant's Signature J <br /> • PLANNING DIV. 1810 E. Hazelton Avenue • PUBLIC WORKS DEPT. 1810 E. Hazelton Ave. • LOCAL HEALTH DISTRICT <br /> 1: Property meets zoning requirements for both 1. PROPOSAL APPROVED SUBJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction r A. Encroachment Permit required 1601 E. Hazelton Avenue <br /> Ye No [71 Zone } B. Surface drainage established as shown 1. PROPOSAL APPROVED SUBJECT TO: <br /> 2. SPL'CIAL CONDITIONS C. Fees <br /> A. School district fee 0),-1tA. Obtaining sanitation permit <br /> a. Connection Fee <br /> b. Buy-in-fee B. Obtain well/ um <br /> B. Floodway as shown 0 P P Permit <br /> C. Flood fringe D C. Change noted 0 <br /> L� 2. REMARKS 2. PROPOSAL DENIED <br /> D. Noise impact � � � <br /> 3. PARCEL MAP NO. 3. REMARKS <br /> 4. REMARKS d %Jtr~. !!ir' date by <br /> f"" f <br /> Fdate —�O b b <br /> LCOD CONTROL: date Y <br /> date _2 by i by <br /> (D=�i.D G. IN SP. 14 (3/83 <br /> PIOt Plan Valid Until <br />