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APPLICATION <br />for <br />APPROVAL <br />for <br />CONSTRUCTION <br />in <br />San Joaquin County <br />Precise location of property <br />Structure address <br />Proposed use of <br />Applicant's Name <br />0 Contractor [71 Authorized Agent <br />Address <br />City I <br />Owner's Name - <br />Address <br />City <br />phone <br />Assessor's Parcel No. <br />page _ <br />parcel_ <br />Subd. <br />unit x _ <br />block n <br />lot +r_ <br />Yes <br />sewers <br />water system 0 <br />drainage system— 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 />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 Applicant's Signature <br />• PLANNING DEPT. 1810 E. <br />Hazelton Avenue <br />1: Property meets zoning requirements for both <br />use and construction <br />1601 E. Hazelton Avenue <br />Yes,t_t�.,i No 0 Zone <br />� <br />2. SPECIAL CONDITIONS <br />' <br />A. School district fee <br />B. <br />B. Obtain well/pump permit— <br />ermit <br />B. Floodway as shown <br />0 <br />C. Flood fringe <br />0 <br />D. Noise impact <br />3.REMARKS <br />3. PARCEL MAP N0. <br />4.REMARKS <br />date by — <br />• PUBLIC WORKS DEPT. 1810 E. Hazelton Ave. <br />1. PROPOSAL APPROVED SUBJECT TO: <br />A. Encroachment Permit required— <br />B. <br />equired B. Surface drainage established as shown <br />C. Fees <br />a. Connection Fee <br />b. Buy -in -fee 0 <br />2. REMARKS <br />date by_ <br />FLOOD CONTROL: date <br />by <br />No <br />O <br />0 <br />0 <br />NL orth <br />r LOCAL HEALTH DISTRICT <br />ENVIRONMENTAL HEALTH DIVISION <br />1601 E. Hazelton Avenue <br />1. PROPOSAL APPROVED SUBJECT TO: <br />A. Obtaining sanitation permit— <br />ermit <br />B. <br />B. Obtain well/pump permit— <br />ermit <br />C. <br />C. Change noted <br />0 <br />2. PROPOSAL DENIED <br />3.REMARKS <br />—I date by °'y <br />�yM�^Bo GG.INSP. 14 (3/79) <br />1 I vWW \ <br />