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BUILDING <br /> 4NSPECTION <br /> <br />Zoning ValiHstlon ',,~.~u~lrtl~ _ . ~ · :~20 High SLeet Nle <br /> <br />Date j ~r'~/__ 'Z- I~nc, i~e 5as-~e? <br /> <br />City Setback Requiremem~ <br /> <br />Front; Rear <br /> <br />Left" I ~-~t <br />Side ~_ Side <br /> <br />Sut~divisJon';¢ Lot ~ <br /> <br />Six # <br /> <br />.... Irreg. Lot z' <br /> <br />Mobile Home <br /> <br />Section / ~.~ t Tewn¢ig~ <br /> <br />Corner <br /> <br />Phone- r Address <br /> <br />T_yp~ of Permit; .,~.New:: [] Addition: [] Demo:: <br />~p'T~ -~['r~Alter,, [] Relocation. U Oct Chg' <br /> <br />Height of 8uildir~ No Stories:: Sq. Ft. Main <br /> <br />-Mo~e Mobile Home ~ Bedrooms: <br />Widl~ Length <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation #: <br /> <br />~___Type of System <br /> <br />Test Holes neady~(_ ~ <br />W311 call when holes ready <br /> <br />Existing. Tank ~izo- <br />Existir~l Drainfield Length <br /> <br />~Type of System,, <br /> <br />-0 4 <br /> ...... y ~'7~'~ <br /> Cross Street.,F <br />? 4- d / <br /> Fleet ~ Zone,, <br /> <br />Total t Spaces <br /> <br />Dale,, Tank Pumped: Existfng Becl~x;~m$ .... <br /> <br />OTHER PERMtTS REQUIRED BY THIS 01:1:,,'I'.: PILUMEIiNG, MECHANICAL, ELECTRICAL <br /> <br /> Bldg. Fee <br /> <br />Mobile Home Fee- <br />Fleet 8urche~ge, <br />Zoning $umha~e <br />State Sumharge <br />Plane Cl~ecl( Pea <br />Site Evel~eti0n Fee <br />Sep~ld Permit Fee: <br />DEC Surcharge. <br />T~ahnieel Review Fe <br />Relnspection Fee' <br />Investigation Fee <br />City Fee: <br /> <br />TOTAL PEE. <br />RECEIPT NO <br /> <br />L <br /> <br /> <br />