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-4- <br /> `� Assessor's Parcel No <br /> APPLICATION Applicant's Nance ___-_.. .. L_ j-�' -- --� "- �' -- I—__ <br /> for Contractor ] Authorize t Agent � book_ <br /> i ,JiJ -�.. <br /> APPROVAL Address -(c - --_ - __��_.-- page------ <br /> for City �� � __ __y_ T phone_� parcel <br /> CONSTRUCTION Owner's Name---"..__J���! <br /> in Address .__- ----._._..--------__-.._ <br /> 1 _ -- __ - .___ -__._..----- unit u <br /> San .loaquin County - <br /> City __�._. . _.. _....... - - phone--- - block <br /> Precise location of property..------------ -._.._...._.._..._ _._....._... _........ ....... - - _..._........... let -._.-.. ..... ----__. . <br /> Yes No <br /> sewers <br /> Structure address Bch '� ___ water system <br /> Proposed use of Structure(s)-.----- __ - __...-...-._...._ ._-V _ <br /> drainage system r ] <br /> DRAW (e) Location of minimum 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 (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 /> North <br /> Bre Pint PM Ory <br /> r <br /> Applicant certifies that the property for which the APPROVAL. is sotight is describec as above and that ail existing structures on the property are <br /> shown on the above plot plan. <br /> Date -- Appli::ant's Signature <br /> • PLANNING DEPT. 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 :IUBJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction A. Encroachment Permit required _--_ r 1601 E, Hazelton Avenue <br /> Yes No ( ] Zone ..-_.__.__........_..___..._...._ 13. Surface drainage estab.ished as shown 1. PROPOSAL APPROVED SUBJECT TO: <br /> 2. SPECIAL CONDITIONS C. Fees A. Obtaining sanitation permit 1 <br /> A. School district fee__ ____._..-.. a. Connection Fee_....._.._._.__-___._._...._..... B. Obtain well:pump permit <br /> B. Floodway as shown-------, b" Buy-in-fee _ -..--- ._ C. Change noted--- -_- j <br /> C. Flood fringe 1 2. 2. PROPOSAL DENIED <br /> D. Noise impact ] 3. REMARKS_- <br /> 3. PARCEL MAP N0, <br /> 4. REMARKS date---by- --- <br /> -_�. _ <br /> FLOOD CONTROL: date. -_..-. date _. by <br /> date by_ — by ___ __.— _.__ _..��...,.____.._._ BLDG. INSP. 14 (3/7101 <br />