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Re,.ived By: ~ t ~ ~ ~ "~-~ I~ARION NTY BUILDING <br />City ' ~ Senator Bldg. No. 225 <br /> <br /> r ,~1~' [PSm:Cl'[O~e"'A-Ph°"e ~:~o ~ - S-Ob ~,~. <br /> GU~ ~ .- .. . <br /> BUILDING ~ MOBILE HOME ~ SEPTIC ~ <br /> <br />INSPECTION <br /> <br />Property Owner; <br /> <br />I_,.Ct~y Setback Requirementa; <br /> <br /> Front: Z- O Rear: <br /> Left Right <br /> <br /> PERMIT APPLICATION <br /> <br />Phone; I Mailing Address: ~:~ .4/ <br /> <br />Job Address; <br /> <br />Site No.t <br /> <br />Property Tax Lot No.: <br /> <br />Cross Street: <br /> <br />Freer S/C Zone; <br /> <br />f2. ¥¢ <br /> <br />. Raage; <br /> t W' <br /> Acres: <br /> <br />Contractor Business Name and NO.: <br /> <br />Phone: <br /> <br />Phone; <br /> <br />Typo of Permit: I New: F~ Addition: <br />~OAi~,,._~:i~.~_' Alter: [] Relocation: <br /> <br />Height of Building; <br /> <br />No. Stories; <br /> <br />Demo; [~ Tach, <br />Ccc. Chg,: [] Review; <br /> <br />Mobile Home Mobile Home <br />Width: Length: <br /> <br />Sq. Ft. Main Floor; Sq. FI, 2nd Floor: <br />,/? Bedrooms; Occupancy; <br /> <br />Use of Building: <br /> <br />Sq. FI, Garage: <br /> <br />Occupant Load: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation #: ¢ ~ J -:~ ~¢' <br /> <br />Type of System; <br />Test Holes Ready: <br /> <br />Will call when holes ready; <br /> <br />Existing Septic System; <br />Existing Tank Si~e; <br /> <br />Proposed Bedrooms: <br /> <br />Existing Drainfield Length:. <br />Type of S~(atem: <br /> <br />Date Tank Pumped; <br /> <br />Existing Bedrooms: <br /> <br /> ~ h~ve read this application in its e~tirety and certify that the stated information is <br /> I em a registered builder OR ( ) the authorized representative ¢ a registered <br /> Other <br /> <br /> - ...... <br />SIGNATURe. OF APPLICAN~~''~ <br /> <br />OTHER PERMITS REQUIRED BY i-HIS DEPT.: pLUM~ING, MECHANICAL, ELECTRICAl. <br />MC lS-6 <br />Rev. 12/87 <br /> <br />RES ~ <br />COM [] <br /> <br />, Other; <br /> <br />Valuation: <br /> <br />Bldg. Fee; <br /> <br />Mobile Homo Fee: <br /> <br />DEQ Surcharge: <br /> <br />Investigation Fee: <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO,; <br /> <br />Water Supply: <br /> <br /> $_ <br /> <br /> $. <br /> <br /> <br />