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COU"Ty"U" '"G'"S"ECT'O" <br /> <br />BUILDING MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Situs Address <br /> <br />Use of ~uilding <br /> <br />Mailing Addrdss <br /> <br />Typeof Permit ,~ New:: I~,/~ Addition"' FI <br /> <br />Township:: <br /> <br />Acrea:: <br /> <br />Tax Lot <br /> <br />Site No :: <br /> <br />Contract City:: UGB <br />Cenatr~otion, Type Occupancy <br /> <br />Subdivision:: <br /> <br />Min Reqd F~ont <br />Setbacks:: <br /> <br />Range <br /> <br />Irreg Lot <br /> <br />Cross Street <br /> <br />Occupant Load <br /> <br />Left I Rieht I Rear <br />/ Corner;: Fleet S/C Zone:: <br /> <br /> Demo [~ Tach <br /> <br />Occ, Chg:: L~ Review [] <br />Phone <br /> <br />Use of Suilding, RES ~ <br /> COM [] <br />AddresS' Y/~ ~ -- <br /> <br />Home BuildeGs Registration No <br /> <br />A~chi eot/Engineer <br /> <br />Phone:: <br /> <br />Height of Building:: No Stories <br />/&/ <br /> <br />Mobile Home Width <br /> <br />Sq Ft Main Floor;; <br />kongth:: <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Water <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Type of System <br /> <br />Test Holes Reedy:; <br />Will call when holes ready <br /> <br /> Sxisting Septic System;: <br />. Existing Tank Size <br />Existin~g Drainfield Length:: <br /> Type of System <br /> <br />Date Tank Pumped <br /> <br />Valuation <br /> <br />SIGNAYUREOFAPPLICANT ~ :~: <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP'E: PLUMBING, MECHANICAL, ELEC3'RICAL <br />MC 15-6 <br /> <br />Address:: <br /> <br />Sq Ft Garage <br /> 'L~/~CZ*~F~¢~, I Other <br /> <br />Bldg Fee:: $ / ~¢, ~""C"~ <br />Mobile Home Fee:: <br />Fleet Surcharge:: -.~ ~'~4~/ <br />Zoning Surcharge <br />State Surcharge ~, ,~. ~ <br />Plans Check Fee:: /1~ ~,~ <br />Site Evaluation Fee <br />Septic Permit Fee:: <br />DEQ Surcharge <br />Technical Review Fee' <br />Reinspection Fee:: <br />Investigation Fee <br />City Fee 4~, ,;~,~¢ <br />TOTAL FEE:: ,~,~,, '~¢~ <br />RECEIPT __'~Z ..... <br /> <br /> <br />