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City ~ t \\ . ?\ .~, '~., Senator Bldg. No. 225 <br /> BUILDING ~ <br /> <br /> City Setback Requiremen~ts; <br /> <br /> Front: Rear; <br /> <br /> [ Side; Side: <br />MOBILE HOME [] SEPTIC E~'~ERMIT APPLICATION <br /> <br />Property Owner; <br /> <br />Job Address: <br /> <br />Subdivision <br /> <br />Mobile Home Park: <br /> <br />S'teH°': SSqL .' <br />Property Tax Lot No.; <br /> <br />LOt; <br /> <br />Phone: Mailing, Address: <br />C~ss Street: <br /> <br /> Fleet S/C Zone: <br /> <br />Sp, #; <br /> <br />Section: ~ ~ Township: Range: I Zone: Map; <br />Lot Width; Lot Depth: Acres: Irreg. Lot: Corner; <br /> <br />Block; <br /> <br />Total # Spaces; <br /> <br />Contractor Bualneaa Name and No.: <br /> <br />Architect/Engineer; <br /> <br />Phone: <br /> <br />Phone: <br /> <br />Address: <br /> <br /> ~.p~...e of Permit; I New; Fq Addition; ~] Demo; E~ Tach. <br /> att (... IAlter; [] Relocation; [] Ccc, Chg,; [] Review: [] <br /> <br />Height of BuUding: <br /> <br />Mobile Home <br />Width; <br /> <br />NO, Stories; <br /> <br />Mobile Home <br />Length; <br /> <br />Sq. Ft. Main FLoor: <br /> <br />Bedrooms; <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Occupancy: <br /> <br />Uae of Building: <br /> <br />Sq. Ft. Garage: <br /> <br />Occupant Load: <br /> <br /> COM LJ <br />Other; <br /> <br />Water Supply: <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation ~; <br />Type of System: <br />Test Holes Ready~ <br />Will call when holes ready; Proposed Bedrooms; <br />Existing Septic System: <br />Existing Tank Size; <br /> <br />Existin~ Drainfield Length: <br />Type of System: <br /> <br />Date Tank Pumped: Existing Bedrooms: <br /> <br /> I have read this application In iat entirety and certify that the stated information is <br /> true and eorreat to the best at my knOwledge, <br /> I am performing work on a property I own or occupy. <br /> I am a registered builder OR ( ) the authorized representagve of e registered <br /> builder, <br /> The work will be performed by a registered builder. <br /> Other <br />(".~') I agree to build according to the subml~_~e4~ans and speolfloatlons, the I~ws of <br /> <br />SIGNATURE OF APPLIC~. ~ ~~'~ <br />OTHER PERMITS REQUIRED BY THIS DEPT,= PLUMIilNG, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 12/87 <br /> <br />Valuation: $ <br /> <br />Bldg. Fee; $ <br />Mobile Home Fee; <br />Fleet Surcharge: <br />Zoning Surcharge; <br />State Surcharge; <br />Plans Check Fee; <br />Site Evaluation Fee; <br />Septic Permit Fee; _~_~.~_~. <br />DEQ Surcharge: <br />Technical Review Fee: <br />Reinapeotlon Fee; <br />Investigation Fee: <br /> <br />City Fee: <br />llZ'TTA L FEE; /~'-"~ <br />RECEIPT NO,; <br /> <br /> <br />