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Applicant's Name (� f 4�✓_ . �/f 7C'/( rL( `Ye-c' <br /> Census Tr. _ <br /> S,�'(Contractor � Owner Q Setback: <br /> Address J_-7--//^ e�.�_!-rf �/7/ _ G -�/� 7��LyIY front <br /> City C left <br /> Zip <br /> -F-�_ phonyz• <br /> Precise location of property) 'y'y7iN0K7' �y JTg'�J��r'`/i Czf-///� right <br /> rear <br /> Yes Nc <br /> Structure address f�Mc, sewers 0 C <br /> water system_O C <br /> Proposed use of structure(s) drainage system_0 L <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) AbuttinR 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 /> 9-L7F-- <br /> - <br /> —T 4 <br /> C/X <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and that all existing <br /> shown on the above plot plan. structures on the property are <br /> Date <br /> Applicant's Signature <br /> . PLANNING DIV. 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 SUBJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction A. Encroachment Permit required 1601 E. Hazelton Avenue <br /> Yes O No = Zone B. Surface drainage established as shown 1. PROPOSAL APPROVED SUBJECT TO: <br /> 2. SPECIAL CONDITIONS C. Fees A. Obtaining sanitation permit <br /> A, School district fee a. Connection Fee B. Obtain well/pump permit <br /> S. Floodway as shown 0 b. Buy-in-fee <br /> C. Flood fringe L� 2. REMARKS 2. PROPOSAL DENIED <br /> C. Change noted <br /> D. Noise impact � <br /> 3. PARCEL MAP NO. 3. REMARKS <br /> 4.REMARKS date by / <br />