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lU) ,~ .... '"~t;~"*"' COUNTY BUILDING INSPECTION <br />~ ~u~ING ~ MOB EE HOME ~ SEPTIC ~ <br /> <br /> ICity Setback Require,re. en~tsl <br /> <br /> Front'.~.~ Rear ,~'~' <br /> LSide; ,,~ S~de: <br />PERMIT APPLICATION <br /> <br />Property Tax Lot No.: <br /> <br />S~,b/.zd ivisio n: Lot: ~ <br />Mobile Home Park,. Bp. ~'. <br /> <br /> Map; <br /> <br />Cross Street; <br /> <br />Fleet B/C Zone; <br /> <br />Block; <br /> / <br />Total ¢~ Spaces: <br /> <br />Section; <br /> <br />Lot Width: <br /> <br />Township: <br /> <br />Lot Depth: <br /> /b~O ' <br /> <br />Cor <br /> <br />' Cog~ractor Business Name and No.: Phone; Address; <br />Archi c'[/Engineerr Phone: Address: <br /> <br />Type of Permit: New: ~r Addition: [] <br /> <br />Demo: [] Tach, <br />Otc. Chg.: [] Review: <br /> <br />Height of Building: <br /> <br />Mobile Home <br />Width: <br /> <br />No. Stories; J Sq,~Floer: Sq. Ft. 2nd Floor; <br />/ l ~ Occupancy; <br />Mobile Home # Bedro6ms: <br />Length: <br /> <br />Use of Building; <br /> <br />Sq, F't, Garage: /' ~iher: <br />Occupant Load; Water Supply: <br />Valuation: $ <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #.; <br />Type of System: <br />Test Holes Ready; <br />Will call when holes ready: Proposed Bedcoorn$; <br /> <br />Existing Septic System: <br /> Existing Tank Size: <br /> ExisUn9 Drainfield Length: <br /> <br />~,.p,e of System: <br /> Date Tank Pumped: Existing Bedrooms: <br /> <br />S GNATURE OF APPLICANT'. <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg. Fee; <br /> <br />Mobile Home Fee; <br />Fleet Surcharge; <br />Zoning Surcharge; <br />State Surcharge; <br />Plane Check Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge; <br />Techalcal Review Fee: <br />Reinepectien Fee: <br />investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br />· <br /> <br /> <br />