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ate .... ..., lift <br /> .... ~l~u~ ~ ~-~o.e~:3o~.~'~, //II <br /> <br /> Owner:: -- <br /> Situs Address ~ite No; Cr~s St~et~ <br /> <br />q 7.5 ~.4~ <br /> <br />Se~ Townshi,:,.3, <br />' Area:: Acres <br /> <br />Contract City:; J UGB:: <br /> / <br /> stru ion e <br /> <br />Subdivision:: <br /> <br />Mtn Reqd. Front, <br />Setbacks ~) <br /> <br />Range, <br /> <br />Fleet S/C Zone <br /> <br />C°~/¢¢acter / <br />Home Builder~ Registration No:: <br /> <br />Addition:: ¢q Demo:: [] Tach,, <br /> <br />Relocation:; E3 Occ, Chg, [] Review;: <br />~/~ J Phone:: <br /> <br />Height of Building:: <br /> <br /> ~/¢ <br />--~' NO Stories:: <br /> <br />Mobile Home:: Width:: <br /> <br />tSq Ft Main Floor:: <br />Length;: <br /> <br />Water ..~pply <br /> <br />Proposed Septic Ins~llafion <br /> Previous Site Eveluatioe ~:; <br /> ~pe of 8~tem:: <br /> ·est Holes Ready;: <br /> <br /> Will call when holes ready:: <br /> <br />Existing Septio System:: <br /> Existing Tank Size <br /> Existing Dreinfield Length <br /> Type of System;: <br /> Date Tank Pumped, <br /> <br />Valuation:: <br /> <br />$ <br /> <br />( ;;~ ) I have road this appliCation tn Ils entirety and certify that the stated information <br /> is true and correct to the best of my knowledge <br />) I am performing work on a property I own or o~ugy, <br />) I am a regIsfetl~d builder OR ( ) the acthori~ed representative of <br /> a registered builder <br /> ~>~-) The wor~ will be performed by a registered builder } Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Roy 3/87 <br /> <br />ISq. Ft, Garage:: Other:; <br /> <br />eldg Fee <br /> <br />Mobile Home Fee:: <br /> <br />neetSu~h~e <br /> <br />Zonif~ Surchexge <br /> <br />State Sumharge:: <br /> <br />Plans Check Fee <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee <br /> <br />DEQ Su~harge <br /> <br />T~hnical Review Fee <br /> <br />Reinspection Fee <br /> <br />TOTAL <br /> <br /> <br />