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~eceived By' ~) ~ /'~_ A~iI(~I~¢ ,,(~' Nt,~--~ BUILDING INSPECTION <br />City ' ' <br /> <br /> BUILD~I~.. ~FT 0 E ~ SEPTIC ~ <br /> <br />Property Owner <br /> <br />Job AddreSs' <br /> <br />Subdivision <br /> <br />Lot Width Lot D~pth ~ Acres:: <br /> :?¢. ¢, <br /> <br />Mailing Address:: . <br /> <br />ProCerty Tax Lot NO <br />L~ <br /> <br />Fleet S/C 7one:: <br /> <br />Block <br /> <br />Zone Mag: <br />Irregi¢~ *,~L°t Cor~ <br /> <br />¢ Ar.celt oct/E ng!'~'eer r. <br /> <br />Phone ~' Address:: <br />Phone, ~ ~ Address <br /> <br />Type o~ Permit:: -~ New [~[~'~" Addition ~Demo [] ' Tach, <br />~¢~ '~j~¢ er ~ Review <br />Height of Building <br /> <br />Mobile Home <br />Width, <br /> <br />Use of Building <br /> <br /> RelocatiOn" [~ Occ Chg,, F~ <br /> <br />No, Stories Scl Ft Main Floor Sq Ft,, 2nd Floor Sq Ft Garage:: <br /> <br /> Occupancy, Occupant Load <br /> <br />Mobile Home # Bedrooms:: <br />Length:: <br /> <br />Proposed Septic Installation' <br />Previous Site Evaluation # <br /> <br />_.T_ype of System <br /> Test Holes Ready <br /> <br />Will call when holes ready Proposed Bedrooms:: <br />Existing Septic SyStem <br />__..Existing Tank Size <br /> <br /> Existing Drainfield Length . <br /> _ Typ~ of System <br /> Date Tank Pump_ed Existing, Bedreems <br /> <br />OTHER PERM TS REQUIRED IB¥ THIS DEPT.: PLUM~ING, MECHANICAL, ~LECTRICAL <br /> <br /> RES E~- '"'" <br /> <br /> COM E3 <br /> <br />IOther <br /> <br /> W~upply <br /> <br />Bldg Fee: <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge' <br /> <br />Zoning Surcharge' <br /> <br />State Surcharge:: <br /> <br />Plans Check Fee <br /> <br /> Site Evaluation Fee <br /> Septic Permit Fee <br /> DEQ Surcharge <br /> Techn/cal Review Fee <br /> Reinspection Fee <br /> Investigation Fee <br /> <br /> City Fee <br /> ? <br />t <br /> TOTAL FEE:: <br /> <br /> REOEIP%NO :: <br /> <br /> <br />