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n <br /> h A P h�'; <br /> St nain� <br /> QMrlr er's,Nam map# <br /> Address bl/lot# <br /> Zip phone <br /> :City' / Census Yr. <br /> Setback: <br /> Applicant's Nam Cont ctor Owner <br /> �q }vont_ <br /> lett <br /> 'Address. ,� / / L � <br /> Zip (� phone V right r <br /> City ry rear <br />'i Precise location of property _ Yes Na <br /> sewers C7 D <br /> II water system CD <br /> Structure address drainage system—© ED <br /> Proposed use of structure(s) <br /> DRAW (e) Location of minimum sewage disposal area for septic tank and leach lines <br /> (a) The lot or,parcet involved, showing shape &dimensions (}) Irrigation of drainages ditches, waterways and drainage ponding areas <br /> (b) Abuttlnl streets:'and other right-of-waynd/ore es to lot lines {h) Levees, with the crownof existj dshrownsed driveways Arad encroachments <br /> (c) The locations:Of all existing build g . <br /> II (d) The IocatiogS of existing and proposed septic tanks and wells (i) WITH DOTTED LINES, THE PROPOSED STRUCTURE or ADDITION. <br /> _ i <br /> I I I 5 k I <br /> i. _ <br /> T o . <br /> I F <br /> _ 7 <br /> : <br /> .l <br /> 1 Li` <br /> l A` <br /> I <br /> , <br /> A 1 ' <br /> I ; <br /> 7. <br /> T. <br /> _. .. <br /> sought is described as above and all a isting structure on a property are <br /> :ant certifies t the pr petty for which the APPROVAL is <br /> I on the above plot plan. <br /> Applicant's Signature <br /> ISTRICT <br /> INNING DIV. 1810.E. Hazelton Avenue • PUBLIC WORKS DEPT. 1810 E. Haze t n Ave. • ENVIRONMENTAL AL HEALTH DHEALTH DIVISION <br /> Yopert�y meets zoning requirements for both 1•PROPOSAL APPROVED SUBJE 1601 E, Hazelton Avenue <br /> r <br /> ie and cons Ion A. Encroachment Permit required <br /> gg <br /> r-0^0 F-1 Zone B• Surface drainage established a shown I] 1. PROPOSAL APPROVED SUBJECT TO- <br /> B. <br />