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APPLICATION Applicant's Name J" Ci i 047f� /lssssaor's Parccf No. <br /> for a2rContraetor [7 Authorized Agent took -_C,P <br /> APPROVAL Address '2 { ; — j T <br /> for City } <br /> CONSTRUCTION phone <br /> I L <br /> Owner's Name / <br /> _ � <br /> Subd. <br /> in Address <br /> San Joaquin County unit f+ <br /> City 17ltpae blink 4. ; <br /> Precise location of property /Y c ,r;Za ,,....._::. V, .(,i <br /> kit a.— <br /> yes No <br /> �, t C� <br /> Stnrcttree address 4? sewaee ©roar sgstom <br /> Proposed use of structures! f I lz ' i '' 0 1 dra4*p system <br /> DRAW tel Location of minimum sewage disposal area for septic tank and lunch lines <br /> (a) The lot or parcel involved, showing shape &dimensions (f) Irrtgatior.or drainages ditches,waterways and drainage ponoling areas <br /> (b) AbuttlnR 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 DC'TTEO LINES, THE PROM6ED STRUCTURE or ADGITICK <br /> _ — <br /> : <br /> _ - <br /> - <br /> j <br /> ter........•-•«.r.,....- 1.7 <br /> � <br /> V. <br /> r <br /> –r t <br /> a <br /> -44 <br /> + + <br /> ........ # - t i { rt r I <br /> • <br /> ,j <br /> 'F <br /> i <br /> m.-._ Appero:, fit'} �l <br /> Applicant certifies that the property for which the APPROVAL is sought is describee as above and that,all existing structures on the property are <br /> �hovrrt Ort the above plot plan. <br /> -)ate Applicant's Applicant's Signature <br /> f L <br /> . MVNING DEPT. 1810 E. Hazelton Avenue a PUBLIC WORKS DEPT. 1810 E. Hazeltw,Ave, a LOCAL HEALTH DISTRICT <br /> I*Vioperty meets zoning requirements for both . PROPOSAL APPROVED '�IJSJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction A. Encroachment Permit rvqulred 1601 E. Hazelton Avenue <br /> Yes No ("� Zone �1`e, - B. Surface drainage estab ished as shown (_) I. PROPOSAL APPROVED SUBJECT TO; <br /> Z. SPE IAL CONDITIONS C. Fees A. Obtaining sanitation permit <br /> A. School district fee Q a. Connection Feer Q B. Obtain well/pump permit <br /> [ <br /> B. Floodway as shown ] b. Buy-in-tee Q C. Change noted <br /> C. Flood fringe U 2.REMARKS 2. PROPOSAL DENIED <br /> i �. <br /> 0. Noise impact <br /> --�*�'--�'- � {' <br /> 3. PARCEL MAP NO. '" - ` + – 3. REMARKS <br /> 4.REMARKS dateil <br /> ��by_ } <br /> FLOOD CONTROL: date. date^1-' 't3 by t <br /> tL <br /> by <br /> R ® 8LDG. FN SP. ft ra�7Pl <br />