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,P <br /> ' ,/o l uy.(J ! rut- � f��. �.� Assessor's�rcel No. <br /> 1 l\ 'r <br /> 444t{CATION Applicants Name book <br /> t�I� I�KJ`ld Age /` (j <br />` +for -. Y page <br /> APPROVAL Address <br /> hone parcel <br /> for Cityf�r1 .47—/21 C.1 i9 t L(, _ sebd. <br /> CONSTRUCTION Owner's Name r ! �� <br /> unit 4 <br /> in Address i• 1f <br /> block u��— <br /> Son Jooquin County Cit rrJ O�y lot s�--. <br /> Yes No <br /> Precise location of property - <br /> sewers C� L-i <br /> ZZ r �uwater system C7 C <br /> ��` drainage system— <br /> Structure address <br /> Proposed use of structure(s) <br /> lel Location d minimum sewage disposal area for septic tank and leach lines r <br /> DRAW (4 dimensions 111 Irrigation or drainages ditches,waterways and drainage ponding areas <br /> (al The lot or parcel involved,showing shape Location of existing and proposed driveways and encroachments <br /> (bl Abutting streets and other right-ofolid/or easements (gt <br /> (c1 The locations of all existing building and distances to lot lines (h1 WITH , <br /> with the crown shown ADDITION <br /> (dt The locations of existing and In <br /> septic tanks and wells (i)WITH DOTTED LINES,THE PROPOSED STRUCTUR a ort <br /> M. .... <br /> R6 <br /> i <br /> 2.ox2D <br /> i z 4r,r <br /> P�'UP Sri <br /> r <br /> r <br /> r <br /> Q <br /> -- - _ Appmx.Scde <br /> Applicant certifies that the property for which the APPROVAL is sought is described as above and tbar all eb ting structures on the prop/perry l> <br /> shown on the blot play L4.�T �J G <br /> Applicant's Signature _F <br /> Date <br /> .PLANNING DEPT. IB10 E.Hazelton Avenue •PUBLIC WORKS DEPT. 1810 E.Hazelt Ave.,. •LOCAL HEALTH DISTRICT <br /> .PROPOSAL APPROVED SUBJECENVIRONMENTAL HEALTH DIVISION <br /> Property meets=Doing require nIs for bath 1601 E.Hazelton Avenue <br /> use a onslrucNon ,�� A. Encroachment Permit <br /> required 1.PROPOSAL APPROVED SUBJECT TO' <br /> B. Surface drainage established as shown Q A Obtaining sanitation permit <br /> Yes No CZone C. Fees <br /> 2.SP 1ALCONDITI0N5 a.Connection Fee— � B.Obtain well/pump permit XD <br /> A.School district fee Qb_ Buy-in ee - - lam, C.Change noted <br /> B,Flrwdway as shown CD yx'r' z.PROPOSAL DENIED <br /> 2.REMARKS <br /> C.Flood fringe �b t•Ot�` S.REMARKS <br /> D.Nolle impact y c.ti- t,1..,by Z - <br /> 3.PARCEL r6lt� date <br /> date—by <br /> 1.R <br /> FLOOD CONTROL[date urs ii�,ra ulnar <br /> by <br /> date - <br /> t ' <br />