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[ -' p , Y 'Address unit <br /> S111:.".. <br /> art 1oa um`Count City <br /> #. <br /> pone hblock;x <br /> Precise location of property lot <br /> (Draw To Scale) Yes I <br /> Structure address -SCALE " TO sewers [] <br /> water system © C <br /> PropAd WA11M&l3tifi C is or roads nearest to or boundin the ro eYt drainage system— <br /> E <br /> DRA (e) o a ion o m�nl�rru se a e dis os I ea for se tic t nk and leachlines <br /> rt�IleXlStin�)agk}` f Tt AMPA�A�i�s�,rd����r{d�Y�l� �6�e�g�4�5�as-patios, <br /> (b) Abutft16�8ME9W8ha-15d VQk6of-way and/or easements 6 (g) Location of existing and proposed driveways and encroachm(e�ntgsppgg <br /> (d) The,of caul of ex ��a pr pip glas�l �{mak and Y[T fir[(hi��ll nT�T NQE TN@E p p TedCST@�}W� E D{DfTION i System, <br /> prop8seO eX cTn IOTI OTS Wi Q13{?OSa SySterp OI ryr1�O[tiBr p0551Df6 St rce• 3C1}1r1 �T1. <br /> s ipe�_.Q.a ae-pr. P adjo, livorth <br /> . 1 <br /> &•. _ d illi � pen y f a r��gft e t <br /> - if <br /> I I , <br /> E <br /> _ _ <br /> f <br /> , <br /> 1 I I i } 1 <br /> r i r ! <br /> 3 e <br /> 1 t <br /> ' �i I <br /> i I 1 _ I <br /> Ij <br /> z 1 E 77 <br /> — _ <br /> i� <br /> f <br /> I <br /> • f I _ <br /> k",-17 <br /> _ I ILLI <br /> .. <br /> j <br /> � I € <br /> i € <br /> . i <br /> E I <br /> -� <br /> Vt <br /> 4-4 <br /> ._ <br /> ...,... - <br /> _ , J I <br /> I <br /> dr <br /> F,...- _.. ..-. ... ..., ... 6..1..... <br /> s i <br /> L : <br /> 1, t-.;- W_. �-1. i. <br /> Y� <br /> — r —t <br /> fa <br /> .. .} I I ..:... <br /> I f <br /> _ -- 1_ <br /> i, <br /> 4­2­ <br /> T <br /> i <br /> _ .... -a <br /> 11 ant er+if e <br /> how on tie a ve lot an: . <br /> ate <br /> Applicant's ign ure <br /> .PLANNING'' IV.`-,18 0,E. Haz [ton ven e • UB"IC OR DE T. 1814 E. H zeit n A e. • L CAI_ HE LTH D1S RIC <br /> ro t <br /> se,a d co stru tloo. A. Enc achrient Permit re(uired 1 16 1 E. HazE Iton Aven ie <br /> 2" PEC AL ON [TIO S, C. Fee k. 0 taini g s nitat on per <br /> mit <br /> rOhio + <br /> B: {ood aq s sh wn b. u fee tain ell pum per it <br /> y_I . C an a note <br /> 2;REMARKS 2. PROPOSAL DENIED <br /> _._.D-Noise tmoact . . 11 _. I--I <br />