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7°ningValidati°e: ¢~ 1 ~ ~987 ~,o~..~ <br /> <br /> '~ARION COUNTY c~.*-.....4,~...-~:eA... <br /> BUI~[~ IN~OME ~ SEPTIC ~ PERMITAPPUCATION <br /> <br />Situs Address; <br /> <br />Tax Lot: <br /> <br />Site No.: Cross Street; <br />Contract Cib/: <br /> <br />UGB; <br /> <br />Occupancy; <br /> <br />Use of Building: <br /> <br />Mailing Address; <br /> <br />Construction Type: <br />Subdivision: <br /> <br />Min. Reqd. Front; <br />Setbacks; ~. (~ <br /> <br /> Block: <br />Width: Depth: ~ Area', <br /> <br />OocupaetLoad: <br /> <br /> Left ~.. Right <br /> Side; Side: -,~' <br />Township; Range: Zone; Map'. <br />Acres: Irneg. Lot: Fleet S/C Zone; <br /> <br />Rear; <br /> <br />Corner; <br /> <br />Type of Permit: New: ~ Addition: [~ Demo; [] Tach, UseofE~uJlding: <br /> RES ~ <br /> Alter; [] Relocation: [] Occ, Chg,: [] Review: ~ <br /> COM [~ <br />Contractor: ~//¢, Phece:~;~y ~ ~.~,.~./f~ Address: <br /> <br />Home Builder's Registration No,: <br /> <br />Architect/Engineer; . ' <br /> <br /> Height of Building; , /: <br /> <br /> Mobile <br /> Home; <br /> <br /> Type of System;Test Holes Re,dy: ~J ~,~J ~C."~ <br /> Will call when holes <br /> <br /> Existing Septic System: <br /> Existing Tank Size; <br /> Exist ng Dralnfleld Lee! <br /> Type of System: <br /> Date Tank Pumped: <br /> <br /> ~) I am performlng work on ~ pmpe~ I own or occupy. <br /> <br /> ) The work will be performed by a registered builder. <br /> <br />SIGNATURE OF APPLI~~ <br />OTHER PERMITS REQUIRED BY THIS DEP[: PLUMBING, MECHANICAL, EE[CTRIC~L <br />MC ~-6 <br /> <br /> Address: <br />FlOOr: Sq, Pt, Garage; Other; <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee; <br />Fleet Surcharge: <br />Zoning Sumharge; <br />State Sumharge: <br />Plans Check Fee: <br />Site Evaluation Fee; <br />Septic Permit Fee'. <br />DEQ Sumharge; <br />Technical Review Fee; <br />ReinspeCtion Fee: <br />InVestigation Fee: <br />City Fee; <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br />$ <br /> ~'~, o 0 <br /> bT. <br /> <br /> ¢¢ <br /> <br /> <br />