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R.~e,¥ed By:: __--~'~"/ .... "'"ION OOUNT¥ BIJILD¢II~'~I:~i~¢I'!,¢ ~ityt%~,tback Requirements <br />C y ' ~ Senator Bldg,, NO ~2~ <br />Zoning Va~d~ion ~ ~ 220 High Street NE <br /> <br /> ............. ~ ION ~ ~ <br /> <br /> 9 ,Ce,. <br />-~;¢~,si~. ..... -;--"? ...... ~_- ............ <br />_ Md, i-, o~ 3 ............. <br />Mobile Home Park <br /> <br />Site No Cross Street:: <br />Property Tax Lot NO :: Fleet <br /> <br />Lot Wid,th LOt Oep h ..... ,~,~; ......... l~rr~;ot <br /> ¢_9_,__a__~. _ <br /> <br />Sp #:: Total # Spaces <br /> <br />Map <br /> <br />Co?~er:: ~ <br /> Uvrn ~ <br /> <br />Mobile Home <br />Width <br /> <br />N~w ~,¢- Addition El Demo:: [] Tach <br /> <br />Alter L~ Relocation I~ Ccc Chg:: LJ Review <br /> s~ ~t ~-~' ~I~;~r <br /> <br />No Stories <br /> / <br /> <br />Mobile Home <br />Length <br /> <br /># Bedrooms <br /> <br />Occupancy <br /> <br /> Proposed Septic InstsIlatlon <br /> Previous Site Evaluation <br /> Type of Sy_~!~m <br /> Test Ho!e~ Ready <br /> Will 0811 when holes ready Proposed Bedrooms <br /> Existing Septic System:: <br /> Existing _Te_n.k Size:: <br /> Existing Drainfield Leng_t_h_: <br /> Type_ of System <br /> Existing Bedrooms <br /> <br />~ ~ I have read this application in its entirety and certify that the stated information <br /> .~tue and correct to the best of mk knowledge <br /> '~,~.¢~ .a, m performing work on a property I own or occupy ~ <br />I ) I am a registered builder OR f I the authorized representative of a registered <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building RES <br /> eom [] <br /> <br />Sq Pt, Garage Other <br />©¢cspant Load:: <br /> <br />Valuation:: <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge:: <br />Plans Check <br /> <br />Site Eve, luation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspestion Fee <br />Investigation Fee <br /> <br />Cdy Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />