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Ai-'NLICATIUN Applicant's Name Assessor's Parcel No. <br /> Ej Contractor LD Authorized Agent book <br /> for -3C <br /> APPROVAL"=' Address paw- <br /> for City phone parcel A2 _.._- <br /> CONSTRUCTION Owner's Name <br /> AddSubd, <br /> to <br /> ion <br /> Address llh1, ro. — .._.. <br /> - unit u <br /> "JOagvih''Covnty ---- <br /> City phone" block-V /1 A <br /> ease location of•property � __4hQro4, L:i, -n,-le lot ni , <br /> Yes r, <br /> r <br /> w <br /> sees G <br /> 'ucture sddresti ' <br /> water system <br /> nposed;pse of structure(s) ' .J drainage system G - <br /> RAW (e) Location of minimum sewage disposal area for septic tank and leach lines <br /> The:lot or,parcel Involved, showing shape &dimensions (f) Irrigation or drainages ditches, waterways and drainage ponding areas <br /> ?•Atiutt[ng streets and other right-of-way and/or easements (g) Location of existing and proposed driveways and encroachments <br /> The locations of all existing building and distances to lot lines (h) Levees, with the crown shown <br /> 0 The locations of existing and proposed septic tanks and wells (i) WITH QOTTED L1NE5,THE PROPOSED STRUCTURE or ADDITION <br /> , <br /> • - - ' •1-.•---)-I-� G ' -•--I I _. 3t-_l1�+ ]}}- FEE - � -, .,..._. Nor:h' <br /> ' r <br /> - <br /> - • 7{ yE-- <br /> {{x_444._ -l........L_..'. _ } _ _ I 4 _ <br /> - Tom ' F' i'7 <br /> J. <br /> .. 1 <br /> a - <br /> } ._ <br /> 1 <br /> 1 I I 1 <br /> .�1- � <br /> I + LL T <br /> _• _ <br /> -10 -T- I 'L ---I-rl -I- , I ! I . I , . - <br /> 41F <br /> _ <br /> 1a. iPr <br /> 1 <br /> I—_._ L 1_•`IH_ 1 J 1 I Appmx- S6 e PI <br /> .•._ <br /> plicant certifies that the property for which the APPROVAL is sought is described as above and t II existing structures on the property are <br /> )wn on the above plot plan. <br /> te- 6 + �---- Applicant's Signa re <br /> ILhNHirrin D]`:. 1g14, , "zi7e9L-0a Avenue s�-iroLi%�vuRK�t�EF-T'.`loiU E- Hazelton Ave. . LOCAL HEALTH DISTRICT ' <br /> 4: Property meets zoning requirements for both 1.PROPOSAL APPROVED SUBJECT O• ENVIRONMENTAL HEALTH DIVISION <br /> use and con n A. Encroachment Permit required 1641 E. Hazelton Avenue <br /> Yes NO © Zone a B. Surface drainage established as s own (] 1. PROPOSAL APPROVED SUBJECT TO: <br /> '-.SPECIAL CONDITIONS L) 0. Fees A. Obtaining sanitation permit <br /> A. School district ie a. Connection Fee Q B. Obtain well/ um <br /> B. Fioodway as shown p p permit <br /> b• K C. Change noted <br /> y-in- <br /> •C. Flood fringe � C: <br /> C7 2. REMARKS' <br /> 2. PROPOSAL DENIED <br /> D,•Noise impact (��/ <br /> PARgL MAP N .8, REMARKS_ <br /> RF-MARKS date 2 by r0k1% 1k <br /> r LOOD CONTROL: date__ __ date by <br /> date <br /> by a BLDG. V <br /> ;1i <br /> g� `7 <br /> 5.i <br />