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APPLICATION Applicant's Name ^j_ T/� ` ! +� Assessor's Parcel No. <br /> for Q Contractor Q Authorized Agent book } <br /> APPROVAL Address ,L. Y;�. /'/ r T page <br /> r- <br /> for City .C_ phone parcel <br /> ra let} <br /> CONSTRUCTION owrier'aName /4 ar7 k�� . -„ _. - subd. <br /> in Address !,,' 4' t.; , : / unit x <br /> Son Joaquin County City 1�) r C' phone block <br /> i <br /> Precise location of property ~---r--.e�: 4110 �,• . <br /> w 1 L.s rte/ lot x <br /> r / Yes No <br /> ` •f sewers Q Cl <br /> Structure address water system_Q E! <br /> Proposed use of structure(s) �' �+ v >✓ ✓�'+ drainage system_Q <br /> DRAW (e)Location of minimum sewage disposal area for septic tank and leach lines <br /> (a)The lot or parcel involved,showing shape i 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 (h)Levees,with the crown shown <br /> (d)The locations of existing and proposed septic tanks and wells (I)WITH DOTTED LINES,THE PROPOSED STRUCTURE or ADDITION <br /> Nath .. <br /> ftu-r w Peak 0* ;r:; <br /> r <br /> V <br /> i � h <br /> Appeox:Scale i-1 -- <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and that all existing structures on the property are <br /> shown on the above plo plan. <br /> Date f` Applicant's Signature Y <br /> e PLANNING'DEPT. 1810 E.Hazelton Avenue •PUBLIC WORKS DEPT. 1810 E.Hazelton Ave. a LOCAL HEALTH DISTRICT <br /> Property meets zoning requirements for both 1.PROPOSAL APPROVED SUBJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction A. Encroachment Permit required Q 1601 E.Hazelton Avenue ; <br /> Yes LD No Q Zone h A 30 B. Surface drainage established as shown Q 1.PROPOSAL APPROVED SUBJECT T0: <br /> 2.SPECIAL CONDITIONS C. Fees A.Obtaining sanitation permit '0- <br /> A. <br /> A.School district fee Q a.Connection Fee Q 8.Obtain well/pump permit Q <br /> B.Floodway as shown Q b. Buy-in-fee Q C.Change noted Q <br /> C.Flood fringe Q 2.REMARKS 2.PROPOSAL DENIED Q <br /> D.Noise Impact Q 3.REMARKSn�M� <br /> 3.PARCEL MAP N0. date by <br /> 4.REMARKS - datelill t-�I10 by <br /> _� FLOOD CONTROL:date <br /> ® <br /> by =�. ,— y�� by aLoo.iNs a�ai�a <br /> ,�� � GJL� 13 <br />