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N0I1]3dSN1 tiNIU ill lid -d :1lvi+4tvv lu a J ,-"- �, o ti I) <br /> v Z Z <br /> NinovOf NVS JO A1Nnoo m m m G n <br /> 0 0 N O <br /> GM i <br /> rcl(DIC, n <br /> G O pco <br /> 0 m <br /> �r i <br /> -- Subd.name <br /> "Tess map N i <br /> Zip phone ��/,�.�[cLQ - - bl/lot# <br /> Census Tr. <br /> .ant's Name ' <br /> ' Setback: : <br /> p Contractor © Owner l <br /> --- front <br /> 'SS. left <br /> Zip phone <br /> —-- right <br /> location of property rear; i <br /> Yes No <br /> sewers <br /> W <br /> '•dil7ess water system <br /> drainage system_ <br /> (e) Location of minimum sewage disposal area for septic tank and leach lines <br /> lot or parcel involved, showing shape &dimensions (f) Irrigation or drainages ditches, waterways and drainage ponding areas <br /> tting streets and other right-of-way and/or easements (g) Location of existing and proposed driveways and encroachments <br /> locations of all existing building and distances to lot lines (h) Levees, with the crown shown <br /> locations of existing and proposed septic tanks and w"c?. -,(tWITH DOTTED LINES, THE PROPOSED STRUCTURE or ADDITION <br /> I I <br /> j <br /> , <br /> ���.. <br /> j t <br /> r <br /> 1 <br /> : <br /> –�— <br /> t <br /> Wv <br /> l <br /> ty for Ich the APPROVAL is sought is described as above and that l! 1 r_._. ... <br /> . ex sting structures on the property areat <br /> , <br /> d � <br /> Applicant's Signature - <br /> 1810 E. Hazelton Avenue • PUBLIC WORKS DEPT. 1816 E. Hazelton Ave. • LOCAL HEALTH DISTRICT <br /> aning requirements for both 1. PROPOSAL APPROVED SUBJECT T25 ENVIRONMENTAL HEALTH DIVISION <br /> tion A. Encroachment Permit required © 1601 E. Hazelton Avenue <br /> Zone' RR-too B. Surface drainage established as shown � 1. PROPOSAL APPROVED SUBJECT TO: <br /> IITIONS C. Fees A. Obtaining sanitation permit <br /> trict fee x.; a. Connection Fee Q B. Obtain well/pump permit <br /> -as shown Q b. Buy-in C. Change noted <br /> ' L= 2. R£l1AAR 2. PROPOSAL DENIED <br /> 3. REMARKS 1) <br /> ].. ' O' date by -Owl �7 <br /> date Lfzz:Q by <br /> FLOOD CONTROL: date <br /> by <br /> by f ® SLOG. INSP. 14 (8/89 <br /> Ad Until 0 -g7 <br />