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 Setbaok Requirements <br /> ~ [ Rear <br /> <br />Property. ~wner PT'~q <br /> <br /> Cross Street <br /> <br />Job Address <br /> <br />Site NO ..~5~ <br /> <br />Section~3~ ] Township:; <br />Lot Width Lot Depth <br /> <br />Property Tax Lot No <br /> <br />Fleet S/C Zone <br /> <br />Subdivision Lot Block:: <br />Mobile Home Park Sp. cf:: Total cf Spaces <br />MAp <br /> <br />W <br /> <br />Zone:: <br /> <br />Irreg Lot:; <br /> <br />Cor <br /> <br />Cent[actor Sustnegs N~,a~e and 'No,:; ,,~':'~-- <br /> <br />Architect/Engineer <br /> <br />Phone:: <br /> <br />Address <br /> <br />Type of Permit <br /> <br />Height Of Building <br /> <br />Mobile Home <br />Width <br /> <br /> Addition ~ Demo [] Tech, <br />Alter ~B/ Relocation:: [] Occ Chg [] Review <br /> <br />No Stories <br /> <br />Mobile Home <br />Length:: <br /> <br />Sq Ft Main Floor <br /> <br />Bedrooms <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br /> UseofBuilding RES <br />[] COM !1 <br /> <br />Occupant Load <br /> <br />Other <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation cf <br /> <br />Test Holes Ready <br /> <br />Will call when holes ready Proposed Bedrooms <br />Existing Septic System:: <br />Existing Tank Size <br /> <br />Existing Orainheld Len_,g_th_ .......... <br />Type of System:; <br /> <br />Date Tank Pump_e_~: .................. Ex!~!?,g Bedrooms <br /> <br />(L--") I have read this application in its entirety and certify that the stated information is <br /> true and correct to the best of my knowledge <br />t ) I 8m performing work on 8 property I own or occupy <br />t ~ I am a registered builder OR ( ) the authorized representative of a registered <br /> builder <br />f ~,,"G' Tl~e work will bo perfonllod by a registered builder <br />f ) Other <br /> ~.¢"~'aeree to eudd according to the submitted plans and specifications the laws of <br />( <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Valuation:: $ ~0 DO <br /> <br />Bide Fee:: $ --.-' <br /> <br />Mobile Home Fee:: <br />Fleet Surcharge ~ -~.i <br /> <br />Zoning Surcharge .......... <br />State Surcharge ~'~' /,'~ <br /> <br />Site E~luatien Fee:: <br /> <br />Sepiic Permit Fee <br /> <br />OEQ Surcharge:: <br /> <br />Reinspectien Fee <br /> <br /> <br />