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C~ly - ' ' <br />Da,a: ?F~J~<[ [~UILDii'~G D!$?ECTION ,ho."s~-ste, <br /> <br /> BUILDING [] MOBILE HOMF- [] SEPTIC [] <br /> <br />INSPECTION <br /> <br />City Setback Requi,r~men~ts: <br />Front; <br /> <br />Side' ~ --{ Side: <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner: Phc'ri'e; Mailing Address: <br /> <br />Job Address: Site No,: Cross Street; <br />Subdivision: L~; <br />Moblle Home ~tk: ............ S~ ~: Total ~ <br />8e~ion: Town,hip; ~nge: ~ne: Map; <br /> <br />Contractor Business Name and No.: <br /> <br />Architect/Engineer; <br /> <br />Phone; <br /> <br />Address: <br /> <br />Typo of Permit; <br /> <br />Height of Building: <br /> <br />Mobile Home <br />Width: <br /> <br />New: ~ Addition: [] Demo: [] Tach, <br />Alter: [] Relocation: []' Ccc. Chg.: [] Review: [] <br /> <br />No. Stories: SCl, Ft, Main FloOr; <br /> <br />Mobile Home # BedroOms: <br />Length; <br /> <br />Sq- Ft. 2nd FloOr; <br /> <br />Occupancy: <br /> <br />Use of Building: <br /> <br />Sq. Ft. Garage: <br />Occupant Load: <br /> <br />Valuation: <br /> <br />Proposed Septic In~llatiee: <br />P~evious Site Evaluation <br /> <br /> T~e of Syste~: <br /> Test Roles Ready: <br />Will call when holes ready: <br />Existing Septic System: <br />Existing Tank Size: <br />Existing Dralnfield Lsagth; <br />Type of System: <br /> <br />Pn;q3osed Bedrooms: <br /> <br />O,~e Tank <br /> <br />RES [] <br />COM [] <br /> <br />Other: <br /> <br />Water Supply: <br /> <br /> Bldg. Fee: <br /> <br /> Mobile Homo Fee: <br /> Fleet Sumharge: <br /> Zoning Surcharge; <br /> <br />State Sumharge: <br />i~.~&tO.o~ ...- Plans Check Fee: <br /> ~ Site Evatuaaee Fee: <br /> o.oo <br /> Septic Permit Fee: <br /> (S~DEQ Sumbarge: <br /> Tecflnical Review Fee: <br /> <br /> Reinspection Fee: <br /> Investigation Fee; <br /> City Fee: <br /> <br /> TOTAL FEE: <br /> RECEIPT NO,: <br /> <br /> <br />