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`o�rff ') �7 <br /> APPLICATION Applicant's Name +tP� 1 � ♦lI>fG9�i�•1 fl/I„�l aJ'i $♦�s7• Assessor's Parcel iNo.._�_. <br /> . for V C ractor CD Authorized Agent ,•t book <br /> _ APPROVAL Address"/ PSI L17" , V?'• li, page <br /> for f y phone — parcel <br /> CONSTRUCTION Owner's Name 't �"t %ik'r/l — Subd. —__— <br /> in Address j A unit a <br /> Son Joaquin County CityDho block <br /> �. <br /> Precise location of property _ -� lot a <br /> Yes No <br /> sewers C.1 <br /> Strpcture address water system_I_j _ <br /> e. <br /> Proposed use of structure(s) .L. drainage system_[-j <br /> DRAW (S) a n of minimum sewage disposal area for septic tank and tach lines <br /> (a)The lot or parcel involved,showing shape&dimensi :(,A!e-e,,is-with <br /> a -or <br /> drainages ditches,waterways and drainage ponding areas <br /> (b)Abutting streets and other right-of-way and/or ease is existing and proposed driveways and encroachments <br /> (c)The locations of all existing building and distance 6 lot lines the crown shown <br /> (d)The locations of existing and proposed septic to and wells - (i)WITH DOTTED LINES,TAE PROPOSED STRUCTURE or ADDITION <br /> N <br /> - <br /> } <br /> t <br /> n i <br /> k <br /> TTt <br /> _ I <br /> L � =0Ajrprox � <br /> property for which the APPROVAL is sought is described as above anaexisting s <br /> d that all itiScaleApplicant certifies that the structures on the property are <br /> shown on the above plot plan. <br /> Applicant's Signature <br /> PLANNING DIV. 1810 EE.Hazelton Avenue •PUBLIC WORKS DEPT. 1810 E.Hazelton Avp ()PAL HEALTH DISTRICT <br /> 1- <br /> wr Roperty meets zoning requirements for both I.PROPOSAL APPROVED SUBJECT TO: / ENVIRONMENTAL HEALTH DIVISION <br /> use and caJstruction A. Encroachment Permit required r/ 1601 E.Hazelton Avenue <br /> Yes 'ND � Zone B. Surface drainage established as shown Q 1.PROPOSAL APPROVED SUBJECT TO: <br /> 9 SPECIAL CONDITIONS C. Fees <br /> 7 A.Obtaining sanitation permit <br /> A.School district fee �'p a.Connection Fee Wm O 8.Obtain well/pump permit <br /> B. Floodway as shown C b.Buy-in-fee = C.Change noted �. <br /> C.Flood fringe Q 2.REMARKS 2.PROPOSAL DENIED <br /> D.Noise impact = 3.REMARKS <br /> L 3.PARCEL MAP N0. date - by <br /> `!4 4.RE RK <br /> c �J•.�r . <br /> FLOOD CONTROL: date date by +- <br /> date by <br />