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· Received By: __ <br /> <br /> City' <br /> Zoning <br /> <br />220 HIGh Street <br /> <br /> Cit¥ Setback Req_u_irements; <br /> <br /> ~,0 ~ear: <br /> <br />Property Owner: <br /> <br />Job Address: <br /> <br />MOBILE HOME [] SEPTICS] PERMIT APPLICATION <br /> Ph~.~ ~-- ~'~,~ '~-I Mailing Addresa; , ~ <br /> Site No.: Cross Street: ) <br /> <br />Property Tax Lot No,: <br /> <br />Fleet S/C Zone; <br /> <br /> Lot'. Block: <br />Subdivision'. ~ '1~-5 E~/_,. ~_-.,~'. ~ I <br />Mobile Home Park'. Bp. ~: Total # Sp~ces: <br /> Range; Zone: Map: <br /> <br />Lot Width: <br /> <br />Township: <br /> <br />Lot Depth; Acres: Irreg, Lot: Corner: <br /> <br />Architect/Engineer; Phone: <br /> Address: <br /> <br />Type of Permit; lNew: <br /> <br />Addition; [] Demo: [] Teoh, <br /> Review: [] <br /> <br />Mobile Home <br />Width; <br /> <br />Use of Building; <br /> <br />'" Sq. Ft. Main Floor'. <br /> # Bedrooms: <br /> <br /> [] Relocation; [] Ccc. Chg.: [] <br /> <br />Height of Building: No. Stories; Sq, Ft, 2nd Floor: Sq. Fl, Garage; Other: <br /> <br /> Mobile Home Occupancy: Occupant Load; <br /> Length; <br /> <br />RES <br /> <br />COM <br /> <br />Water Supply'. <br /> <br />Valuation: $ <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #; <br /> Type of System; <br /> <br /> Test Holes Ready: <br /> <br /> Will call when holes ready: <br /> <br />Pr..o. poaed Bedrooms; <br /> <br />Existing Septic System; <br />.... Existing Tank Size: <br />Existing Dralnfleld Length: <br />Type of System; <br />Date Tank Pumped; Existing Bedrooms'. <br /> <br /> builder. <br /> <br /> Other <br /> <br />SIGNATURE OF APPLIBC-A~[¢¢~-~~ ~:~ * '~"~'~'='~=" <br /> <br />OTHER PERMtTS REQUIRED BY THIS DEPT,~ PLUMBING, MECHANICAL, ELECTRICAL <br />MC t5-6 <br />Rev. 12/87 <br /> <br />Bldg, Fee: <br /> <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 />Reinspection Fee: <br />Investigation Fee; <br />City Fee; <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br /> <br />