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'~Contracto~"bueiness Name and No.. <br /> <br />Phone- Address- <br />Phone Address. <br /> <br /> '~pe of Permit- j New ~ A~dltlon: [] ' Demo: EJ Teoh. <br /> Alter E~ Relocation: r'q Occ Chg ~ Review: <br /> <br /> Height of Bui,ding. ~No ',0~e,' I~,,~,Ft Main F,OO,.~,,',~ Ft. 2~ Floor- <br />'~obile Home " I Mobile Home ~ ~ ~dr~ms: .... ~ <br /> <br />Progoeed BepSc Installation: <br />Previews Site Ev'aluatioe #. <br /> <br /> ~¢pe ef By.stem <br /> Test Roles Ready <br /> Will call when holes re.~d¥ <br /> Existing 8eptlo System <br /> <br />~n~ Ominfield ~n~ .. <br /> Date Tan~ ~mped' <br /> <br />Pro0osed Bedrooms: <br /> <br />Exi¢i~ Bed's: <br /> <br />Use of BUil~i~; <br /> <br />Sq-Ft Garage: <br />Occupant <br /> <br />81GNATURE OF APP~.ICANT , .~~.~.~ -- <br />OTHER PERMITS REQUIRED BY THI~ DEPt..' PLUMBJNG~ MECHANICAL, ELECTRICAL <br /> <br /> RES <br /> C/DM <br /> <br />tW~ter Supply <br /> <br />Bldg Fee; <br /> <br />Mobile Home Fee <br />Pleat Surcharge <br />Zoning Surcharge. <br />S~ate Surcharge: <br />Plane Check Fee <br />~[te Ev~uati~n Fee: <br />Sepbc Permit Fee <br />OEO ~umharge- <br />Technical Review Fee <br />Relnspection Fee- <br />Lnvestlgation Fee <br />City Fee- <br /> <br />TOTAL FEE: <br />RECEIPT NO <br /> <br />..... <br /> <br /> <br />