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zC~in' Validation ~72n COUNTY.~netorBUILDINGs~=g,, .o,, =ts INSPECTION <br />· g · · __ ~.~¢-_ 220 High Street NE <br /> <br /> BUILDING [~MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />P~..~Owner i Phone Mailing Address <br /> <br />etba k Requirements <br />[Left <br /> <br />Job Address <br /> <br />Property Tex Lot No <br /> <br />Fleet S¢C Zone <br /> <br />Block <br /> <br />Subdiw. S],on Lot <br />-~ie Home Park Sp # Total # Spaces <br />zon , <br /> <br />Irreg ,~ <br /> <br />~traotor Business Name and N~ :: <br />Arc,~hitect~Engineer <br /> <br /> Phone;: <br /> <br />"Phone <br /> <br />IAddress <br />Address <br /> <br />~4eig~t "o¢ Building <br />W~dth:: <br /> <br />New ~J~""" Ad~iiii~ [] Demo [] Tach <br />Alter [~ Relo~ation [] Coo Ohg [] Review <br /> <br />No Stories:: <br /> / <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main FlOOr:: <br /># Bedrooms <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Proposed Septic Installation <br />Previou3 Site Evaluation # <br /> <br />Type_of System <br />Test Holes Ready <br /> <br />Will call when holes ready <br /> <br />Proposed Bedrooms <br /> <br />Existing Septic System <br />6xist!~ Tank Size <br /> <br />Existing Drainfietd Length <br />Type of System <br />Bate Tsnk Pumped <br /> <br />Existing Bedrooms <br /> <br />OTHER PERMITS REQUIRED DY THIS DBPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Use of Building RES ~ <br /> <br />Sq Ft Garage I oin-er <br />Occupant Load l~__ Sup ply <br /> ~¢. ¢ <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic B,.%it Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> i¢.¢0.. <br />_.1~15 'Z ~_ <br /> <br /> /¥. qo <br /> <br /> __ <br /> <br /> <br />