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APPLICATION <br />for <br />APPROVAL <br />for <br />CONSTRUCTION <br />in <br />Son Joaquin County <br />Precise location of property <br />Structure address <br />Proposed use of structure(s) <br />Applicant's Name <br />E:i Contractor <br />Address <br />City <br />Owner's Name <br />Address <br />City <br />[] Authorized Agent <br />phone <br />phone <br />Assessor's Parcel No. <br />book <br />page <br />parcel <br />Subd <br />unit n <br />block # <br />lot x <br />1601 E. Hazelton Avenue <br />Yes <br />sewers <br />0 <br />water system <br />F-1 <br />drainage system— <br />0 <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) 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 (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 />No <br />O <br />O <br />(] <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. <br />Date .Q U• <br />• PLANNING DEPT. 1810 E. Hazelton Avenue <br />1. Property meets zoning requirements for both <br />use and construction <br />Yes I No = Zones-_( $J <br />2. SPECIAL CONDITIONS <br />A. School district fee <br />B. Floodway as shown Q <br />C. Flood fringe <br />D. Noise impact <br />3. PARCEL MAP NO. <br />4.REMARKS <br />by <br />Appiicant s Signature -.° 9ga �_. 41M --,f <br />-,,/.-//ri?i >• ) <br />• PUBLIC WORKS DEPT. 1810 E. Hazelton Ave. <br />I. PROPOSAL APPROVED SUBJECT TO: <br />A. Encroachment Permit required 0 <br />B. Surface drainage established as shown <br />C. Fees <br />a. Connection Fee 0 <br />b. Buy-ir fee E] <br />2. REMARKS <br />date by <br />FLOOD CONTROL: date <br />bV <br />LOCAL HEALTH DISTRICT <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Avenue <br />1. PROPOSAL APPROVED SUBJECT TO: <br />A. Obtaining sanitation permit <br />B. Obtain well/pump permit <br />C. Change noted <br />2. PROPOSAL DENIED <br />0 <br />3. REMARKS J /'... // Etr.-- o <br />.� . n. <br />i <br />date by <br />BLDG. INSP. 14 (3/7W <br />