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Assessor's Parcel No._ <br /> _APP OC'ATION Applicant's Name �.�_[!� _ __ r,a„ <br /> L] ontr or I Au ori. ed Agent book .+ <br /> far � <br /> APPRov{1I_ Address paw <br /> for City <br /> parcel <br /> CONSTRUCTION Owner's Name —= ----__-- ___ -- ----- __ Subd. <br /> in Address <br /> - ---- ---------- _._--- ----- - unit u ------ - <br /> Son Joaquin County City � phone <br /> --- ' --— - - block i-T- <br /> Precise location of property ��_ -- — ----.-- ---- lot 9 <br /> Yes No <br /> sewers <br /> Structure address film _ water system <br /> i — [] <br /> Proposed use of structurefs) �__..__s,^� drainage system <br /> DRAW (e) Locatir n of minimum sewage disposal area for septic tank and leach lines <br /> (at The lot or parcel involved, showing shape &dimensions (t) Irrigati -n or drainages ditches, waterways and drainage ponding areas <br /> (b) Abutting streets and other right-pf-way and/or easements (g) Locati+n of existing and proposed driveways and encroachments <br /> (c) The locations of all existing building and distances to lot lines 4h) Levees with the crown shown <br /> (d) The locations of existing and proposed septic tanks and wells (i) WITH E OTTEO LINES, THE PROPOSED STRUCTURE or ADDITION <br /> + , i I North <br /> 47 <br /> i ± ! <br /> #rill ►M4Mf 1'rw� � ; � � <br /> , <br /> LSP S <br /> 94' ' <br /> t I <br /> j <br /> applicant certifies that the property for which the APPROVAL is sought is descrit A as above that all a 'sting structur the property are1t <br /> ,gown on the above pial pian. <br /> ApF!icant's Signature.. <br /> . <br /> PLANNING DEPT. 1810 E. hazelton Avenue • PUBLIC WORKS [A FIT 1 tlo E. Haceltun • LOCAL 11LAI_TH DISTRIC r <br /> 1. NiA;i ty ri,seIs zoning requirements tot both I. PROPOSAt A['F'NOvr..i SUBJFCI TTS: ENVIRONMENTAL. HEALTH DIVISION <br /> use and cor)Wuctlon r A. Encroachment Perna required 1',"I 1601 F- Hazelton Avenue <br /> Yes (,�'No l' 1 Zone- k B. Surface drainage est,blished as shown I 1 1. PROPOSAL APPROVED SUBJECT TO: 4 <br /> 2. SPECIAL CONDITIONS C. Fees A. Obtaining sanitation permit_..-.._....__.._ <br /> A. School district fee [ ] a. Cunne-tion Fee B Obtain well,pump permit <br /> b. <br /> C. Change noted <br /> B. Flood way%s shown -_-- (.- 2. REMARKS <br /> tee 1 �1 2. PROPOSAL DENIED_- �--_ <br /> C. Flood fringe <br /> D, Noise impact C] -._.--- 3. REMARKS <br /> 3. PARCEL MAP NO. --�"�-- - -- - <br /> date _ _ __ by <br /> 4 REMARKS- <br /> date ---�--- -_bye_------ r. <br /> FLOOD CONTROL: - <br /> date '1 by ! by — _ a GLnG. INSP. 14 i3 1v. <br /> is <br />