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_ o-ice <br /> APPLICATION Applicant's Name +" c - :or's Parcel No <br /> for L".l am L.1 Authorized Agent wok Ca 03 -- <br /> APPROVAL Address % - - -� Qn <br /> Yr page for City 1 ' / phone <br /> --� Lr/ parcel _._ <br /> CONSTRUCTION owner's Name r - Subd. <br /> in Add ' - <br /> ress / <br /> / ✓ _ � � - unit u <br /> Son Joaquin County City % -� phone '7it / block++ <br /> Precise location of property 0,1 <br /> a lot Y <br /> C'�"�_ •i—� i 14,r 1_ �n Yes No <br /> sewers CI i <br /> Structure address ''J ( /.- - water system_F-I <br /> .- . <br /> Proposed use of structure(s) SI�X�-!�C'. C�h-/ �C� r'E_vlChE'.a<:r-/a drainage system_ <br /> DRAW (e)Location of minimum sewage disposal area for septic tank and leach lines <br /> fat The lot or parcel involved,showing shape&dimensions (f) Irrigation or drainages ditches,waterways and drainage ponding areas <br /> (bt Abutting streets and other right-of-way and'or easements (g)Location of existing and proposed driveways and encroachments <br /> (c)Thelocations 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 /> NL Orth , <br /> Qi -7 cry S <br /> �1LJt_, <br /> � I' <br /> 1' ( <br /> fp�• i 'Ttil <br /> ± n L <br /> 1 I <br /> r <br /> i <br /> - I <br /> V1 ! <br /> App— Scslt(— <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and that all existing structures on the property are <br /> shown on the above plot plan. i <br /> Date Applicant'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 SUBJECT T0: ENVIRONMENTAL HEALTH DIVISION <br /> use and construction �� A. Encroachment Permit required'-' '' �['] 1601 E.Hazelton Avenue <br /> Yes � No Q zone (o.k',,T L40 B. Surface drainage established asas sho Q 1.PROPOSAL APPROVED SUBJECT TO: <br /> 2.SPECIAL CONDITIONS C. Fees A.Obtaining sanitation permit [ <br /> A.School district fee Q a. Connection Fee Q B.Obtain well/pump permit �( <br /> B. Floodway as shown Q b. Buy-in-fee Q C.Change noted Q <br /> C.Flood fringe Q 2.REMARKS(' - 2.PROPOSAL DENIED Q <br /> D.Noise impact Q 3.REMARKS-T) _ t <br /> 3.PARCEL MAP N0. date by <br /> 4.REMARKS, 141, rc4 -.I �1/ � c data�.,...-�--�--by- <br /> FLOW CONTROL: date L)-;',-'d- •���,._ `•. <br /> datr� <br /> is'za� <br /> by 1-7 r-r 17!i x;: �r by '9 a oc`rrTso. ri <br />