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~e~e,ved~a~~ ~ ,M~Aj~IOR-COUNTY BUILDING INSPECTION <br />City (~'-~-~,~y~ j' Senator Bldg. No. 225 <br /> <br /> uL C:.:uNTY ~lem, 0~0" ~3~ <br /> <br /> .U L NG MOmL HOME SEPTIC <br /> <br /> City Setback Requirem?n.~t$: <br /> <br />j Fr°nt; ~,01 Rear; i'D <br />Left Right ,/ <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner; .......... Phone: "' Mailing Addres~'- <br />Job Address:/~----.~--'~-~ Site No.: Cross Street: <br /> Prope~y T~ ~t NO.: Fleet S/C Zone: <br />~oblle H~me ~rk; Sp. ~: %tal ~ Spies: <br /> <br /> 8e~ion: T~nshlp5 Range: Zone: Map: <br /> ~t Width: ~t Depth: ~res: Irr~, ~t: Corner; <br /> <br />Phone; <br /> <br />Address: <br /> <br />Architect/Engineer: Phone: Address; <br /> <br />Typo of Permit: [ New: <br />~ ~-r ~. ~ I Alter; <br /> <br />Height of Building; <br /> <br />(~/ Addition: [] Demo: [] Tach, <br />[] RelOcation; [:3' O~c. Chg,: [] Review; [] <br /> <br />No. Stories; <br /> <br />Sq, Ft. Main Floor; <br /> <br />Sq, Ft. 2nd <br /> <br />Use of Building: <br /> <br />Sq. Ft, Garage: <br /> <br />Mobile Home Mobile Home ~ Bedrooms: Occupancy: Occupant Load: Water Supply: <br />Width: Length: ~ ~-~ <br /> <br /> Valuation: $_ <br /> <br />RES [] <br />CUM [] <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation <br /> <br />Type of System: <br />Test Holes Reedy: ~.~=.~, <br />Will call when holes ready: Proposed Bedrooms: <br />Existing Septic System: <br />Existing Teak Size: <br /> <br /> Exi~ng Dratnfieid LOn~: <br /> Type, o[.,,~stem; <br /> Date Tank Purn~ Existing Bedrooms; <br /> <br /> ) I am pedoi,mlng w~k o~1 a 13mperty I own or occupy. <br /> <br />SIGNATURE OF APPLICANT: .:' .~' .~--~-.~ -- <br /> <br /> Bldg. Fee: <br /> <br /> Mobile Home Fee; <br /> Fleet Surcharge: <br /> Zoning Sumharge: <br /> <br /> State Surobmge: <br /> ~)~-1~,::).4:~,. Plans Check Fee: <br />40 i~O'OO)Site Evaluafl°n Fee: <br /> Septic Permit Fee: <br /> <br /> (S'~DEQ Surcharge: <br /> Technlc~[ Review Fee: <br /> <br /> Reinspection Fee: <br /> Investig~on Fee: <br /> City Fee: <br /> <br /> TOTAL FEE: <br /> RECEIPT NO.: <br /> <br />el'HER PERMII~ REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />"l q ;.oo <br /> <br /> <br />