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' Assessor's Parcel No. <br /> APPLICATION Applicant's Name <br /> �]Contractor Authorized Agent - bookfor <br /> paw <br /> APPROVAL Address <br /> for City `` "'-'" phoned parcel . <br /> CONSTRUCTION Owner's Name - l" - Subd. <br /> unit a - •:i.�+>., -. - <br /> in Addfess <br /> Son Jaoquin County Cit _ phone - block N - - <br /> y <br /> lot a <br /> Precise location of property Yes No <br /> sewers <br /> water system Ai`w <br /> Structure address "s _ <br /> drainage system—Q <br /> Proposed use of structure(s)/ <br /> DRAW ,(e)Location of minimum sewage disposal area for septic tank and leach lines <br /> (a)The lot or parc0 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 /> North- <br /> . ... �- .. - .. <br /> J, <br /> -'- 17 _ <br /> 1 � <br /> 1 i o.. <br /> r�•. - T. <br /> 1 <br /> 'r Appre.Scete i <br /> r ' <br /> i <br /> } Applicant certifies that the property for which the APPROVAL is sought is described as above and that all existing structures on thepropertyare <br /> k shown on the above plot plan. _ y <br /> Applicant's Signature <br /> Date PP ' - - <br /> i- <br /> •PLANNING DEPT. 1inR eE.q Hazelton Avenue • 1.PRtiP45 L APPROVED SUBJECT TO:ORKS DEPT. 1810 E,Hazelton Ave. '� NV RONMENTAL HEALTH DIVISION <br /> AL HEALfH DISTRICT <br /> 1.Property meets zoning requirements for both A Encroachment Permit required © 1661 E.Hazelton Avenue <br /> use and construction i <br /> I �- �.� B. Surface drainage established as sh n 1.PROPOSAL APPROVED SUBJECT TO: <br /> d Yes No 0 Zone --�--. A,Obtaining sanitation permit ED <br /> I 2.SPECIAL CONDITIONS C• Fees <br /> 4 <br /> A.School district fee CI a. Connection Fee B,Ob in well/pump permit Q <br /> ` B, Floodway as shown C7 4. Buy-in-fee O ange n <br /> .PROPOSAL DE)IED <br /> C.Flood fringe L- 2.REMARKS - <br /> D.Noise impact ELI - <br /> 3.PARCEL MAP NO. date by--------1 i <br /> - by <br /> S <br /> 4.REMARKS ll date I�r <br /> FLOOD CONTROL: date\\ <br /> ® BLOG- NSP. l3/70] <br /> date by by / <br />