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APPLICATION FOR APPROVAL FOR DEVEL60MENT PLAN FOR MOBILEH.OME <br />Permit n MH - SZ -4-1 <br />Receipt #,t7 <br />Lpplicant's Name T�i%%/'^t' <br />a hwmellez✓ <br />Book <br />Authorized Agent <br />Address ro 5' �' <br />�?�/ T�t',9 { !�./iQPhone/�z- <br />•� <br />l 7 93 <br />City 7 <br />Parcel <br />)caner s Name <br />Address <br />/yOiyi£/Tr eA? 4X�LeoPhone <br />s� <br />City <br />?recise Location of Property SW <br />C*d,e.rif2 of 7`/Pi/ice_ <br />126 <br />d <br />structure Address fd:� rP'a'e <br />Pronosed Use of Mobilehome(s)_�'�r'�`� <br />Public Sewer ❑ Yes <br />Draw: <br />(a) The Lot or parcel involved, showing shape and dimensions. <br />(b) Abutting streets and other rights of way and/or easements. <br />(c) The locations of all existing buildings and distance to lot lines. <br />(d) The locations of existing and proposed septic tanks and wells. <br />(e) Location of minimum sewage disposal area for septic tanks and <br />leach lines. <br />Assessor's Parcel No <br />Book <br />Page <br />Parcel <br />( ) Agriculture Worker <br />( ) Accessory <br />( ) Caretaker <br />( )Construction <br />Acreage <br />Public Sewer ❑ Yes <br />�No,.. <br />Public Sewer ❑ Yes <br />�b <br />(f) Irrigation or drainage ditches. <br />(g) Location of existing and proposed driveways and <br />encroachments_ <br />(h) WITH DOTTED LINES THE PROPOSED MOBILEHOME- <br />NOTE> <br />UPON APPROVAL OFTHE PLANNING DEPARTMENT, HEALTH DISTRICT AND ' Approx Scale o <br />A MOBILEHOME SET-UP PERMIT MUST BE SECURED FROM THE -BUILDING INSPECTOR. _ c <br />MIED <br />VAL IS SOUGHT IS AS DESC <br />APPLICANT CERTIFIES THAT THE PROPERTY FOR WHICH THIS APPR SH01NN'ONTHEABOVi`PLOTPBAN. <br />ABOVE, AND THAT ALL EXISTING STRUCTURES ON THE PROPERTY ARE <br />Date rz' Applicant's Signature <br />PUBLIC WORKS DEPA)rt ENT S.J. LOCAL HEALTH DISTRICT <br />DI-ANNING DEPARTMENT ��,�ii�� AltoEnvironmental Health Dlvision <br />