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^C <br /> •Application d . s ri <br /> QTY DEPARTMENT DF PLANNING ANn f}IIILn)ur. runn��TIOPN <br /> A P N <br /> Solid name <br /> L r1 ,.,p phone —. bl lot ------- <br /> I Cens.rs Tr. I f a <br /> - - --- Setback: k; <br /> [ Conlraclor 0•nr r <br /> front <br /> L� 4 ( a <br /> telt <br /> y _ <br /> � 7 � c. <br /> l Zip _ i _ phone `I 7 _i _y_ -_ <br /> i •Q. <br />- I nght---------- <br /> opertY -----..- -- — — <br /> rrrr <br /> Yes No a <br /> sewers <br /> water system <br /> drainage system <br /> ter Location of minimum sewage disposal area for septic tank and leach lines t <br /> iarcel involved,showing shape b dimensions !1) Irripation or drainages ditches,waterways and drainage ponding areas <br /> reets and other right-of-way and/or easements (p•) Loc:,',nn of existing and proposed driveways and encroachments <br /> ins of all existing building and distances to lot line, (h) !^v••.•,. w11h the clown shown---- ----- - <br />,ns of existing and prrrosc:t septic tanks and wells (r) WITH DOTTED LINES.THE PROPOSED STRUCTURF1a ADDITION <br />'IOC PW t <br /> i <br /> : 14. <br /> U--- <br /> if <br /> hat the property for which the APPROVAL Is sought is desrfibed as above and!hat all elt(tting structures o the pro fly, <br />,,lot pl <br /> Appl,Lant's $ignatur� ! \ <br /> 1810 E.Hazelton A,,enue • PUBLIC WORKS DEPT. 1810 E. Hazelton Ave. • LOCAL HEALTH DISTRICT <br /> zoning requirements for both PROPOSAL OOROVCn CLIBJECT TO: ENVIRONMENTAL HEALTH DIVISION <br /> rction A. Ercrnar-hmrnt Permit rrquirnd__-.-._— Q 1601 E. Hazelton Avenue <br /> I Zone___— B. Sutface or,,r,.•p,•est.rt+l,.lied as shown L3 1. PROPOSAL APPROVED SUBJECT TO: <br /> DITIONS C. Fees A.Obtaining sanitation permlt_---- y <br /> strict fee_—_ ! I a. Co,mgr r,nn r`ee. Q B.Obtain well pump permit — <br /> :,s b. g <br /> C. Change noted—...r.._•..._ i <br /> 2.RErRKS. Ji—� 2. PROPOSAL DENIED - <br /> ,.t <br />