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�i APPLICATION Applicant's Name AL1%� fQ ('rt F � _ _ _ Assessor's Parcel No.. <br /> !!' f [.,Contractor Cj]Authorized Agent book— <br /> for � 7� <br /> �-e APPROVAL Add ress l_DI W r A-�A-1{'max.r'�r Fl IJ—J A- ! -- page 7 rL <br /> F " For City r"� C-c- phone 93,�7a�_ parcel 7i( <br /> CONSTRUCTION Owner's Name 1 - SjocL � <br /> in Address - unit n_16,__- <br /> Son Joaquin County Cityy phone ���Zbloclra �U <br /> Precise location of property � r'� �� �� LI J�Q e0 Y lot <br /> Yes No <br /> sewers Cl <br /> Structure address water system_0 C_; 1 <br /> r <br /> drainage system <br /> Proposed use of structure(s)—��'� 1 F!11��, <br /> DRAW {el Location of minimum sewage disposal area for septic tank and leach Eines ! - <br /> (a)The lot or parcel involved,shcwing shape&dimensions {f) rtTgatTon or drainages ditches,waterways and drainage ponding areas <br /> (bl 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 lh)Levees,with the crown shown <br /> ' (dl The locations of existing and proposed septic tanks and wells (i) WITH POTTED LINES,THE PROPOSED STRUCTURE or ADDITION //�\ <br /> Wit <br /> - - , Approxi ScIdt-I <br /> i NN1 C j <br /> Applicant rtifies tha-t the property for which the APPROVAL is sought is described as above and L at 311 existing Structures on the property are <br /> shown o/l the above plot plan- <br /> Date._ Applicant's Signature 57 <br /> .PLANNING DIV. 1810 E.Hazelton Avenue . P,UBLIC WORKS DEPT. 1510 E.Hazel,-6v,/. + LOCAL HEALTH DISTRICT _ <br /> 1.Property meets zoning requirements for both I.PROPOSAL APPROVED SUBJECT TVIRCNMENTAL HEALTH DIVISION - <br /> s use and con truPtion A_ Encroachment Permit required <br /> -1501 F.Hazelton Avenue I' <br /> Yes [ D 'Lj Zone -'✓ /¢--'T�f� B. Surface drainage established a5 shown 1.PROPOSAL APPROVED SUBJECT TO: r�y <br /> 2.SPECIAL CDNDITIONS C- Fees A.Ohtaining sanitation permit Fes' <br /> A.School district fee a. Connection Fee Q B.Obtain well/pump permit <br /> B. Floodway as shown © b. Buy-in- e Q C.Change noted [] <br /> C. Flood fringe Q 2,RE R `� 2.PROPOSAL DENIED 0 <br /> k s D.Noise impact - <br /> 3.PARCEL MAP NOP='�S'�/�,-� date by 3.REMARKS__..! / - <br /> 4-REMARKS ' _ i. ,..1� _? <br /> date Y;� by <br /> FLOOU CONTROL: dateIr <br /> Y� <br /> !" <br /> 1' f <br /> date by by <br /> r <br /> . Z <br /> I �D <br /> r <br /> i' . <br />