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Received B,y,~ .. ~ <br />Zoning, Validation <br /> <br />Bate <br /> <br /> etbaok Requirements~ P <br /> sen~ mdU,~o~S , LI_J J <br /> <br />BUILDING ~ MOBILE HOME ~ SEPT C ~ PERM[~A~LICAT ON <br /> <br />Property Owner <br />Job Address -' ~ ' ' .... <br /> <br />~u~ivimon <br /> <br />M~ile Home ~k <br /> <br />I %rownehtp ...... Range <br />Lot DOP~h. Asres <br /> <br />Lot W[dth <br /> ~.0 <br /> <br />Phone Mailif~g <br /> <br />Property Tax Lot No <br /> <br />Lot; <br /> <br />S~ # <br /> <br />Fleet S/C Zone <br /> <br />BIDER <br /> <br />Zone· mA Map. <br />JrregTLoT Corner <br />5 '7," <br /> <br />f oa~r ~uslness Name end No <br /> r~hitectfEhgineer <br /> <br /> Type of Permit New <br /> <br />Mobile Home <br />Width- <br /> <br />Phone: Address <br /> <br />I~' Addition- [] Demo. <br />LJ Relocation: ~ Ucc Chg <br /> <br /> No. Stories- / Sq. Ft. Main ~10or' <br /> Mobile Home ~ IBedrooms <br /> Length <br /> <br />[] Tecb <br />t-I Review- [] <br /> <br /> ISq Ft 2nd Floor' <br /> OcCupancy <br /> <br /> Proposed Septic <br /> <br /> ~ Previoue $it~,,Evaluatio~ <br /> Ty~[~tem: <br /> Test Hole~e~. <br /> will cell ~en holes rea~ <br /> Exl~t[n~ Septic System <br /> BxlS~ing Tank <br />. Existing D.. rainfleld Lengt~. <br /> ~pe ¢ S~tem, <br /> Date Tank Pum~;,' <br /> <br />Proposed Bedrooms <br /> <br />Existing ~ed?oms- <br /> <br />3'he work will be performed by e registered I~der~ <br /> <br /> .~ yy , .. <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br />document Load <br /> <br />Valuatten- <br /> <br /> Bldg. Fee: <br /> <br />Moblfe Home Fee <br />FJeet Surcharge' <br />2~Onir~g Surchaf~le <br />State Surcha'ge <br />Plans Check Fee <br />Site Evaluation Fee: <br />Septic Permit Fee <br />DEQ Surcharge. <br />Technical Review Fee" <br />Relnspection Fee <br />Ihveetlgation Fee" <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO,' <br /> <br /> __RES <br /> eOM <br /> <br />Other-~ <br /> <br />WaJer Supply <br /> <br /> <br />