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Raceived ~y'. ,[(/I/l(~(~ =MA~ u VCO~JN~¥jBUiLDiNGi TI <br /> - ~T~t RION INSPEC <br /> ON <br /> <br />D~,~,. ~/~[ /~ L"~A~ON COUNTY ..o.~e~,*~ <br /> <br /> BUILDING ~ <br /> <br /> City Setback ReqUirements; <br /> <br /> Front: ]~ <br /> Lift ] Right <br /> I Side: I Side: <br /> <br />MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Property Owner; Phone: <br />...... O(4x, r d. <br />Job Address', ~70 <br /> <br />Subdivision; <br /> <br />Mobile Home Perk: <br /> <br />Section: <br /> ! <br /> <br />Lot Width; <br /> <br />/0o <br /> <br />Site NO.: <br /> <br />Mailing Address: ~'7'~'~ <br /> <br /> Cross Street; <br /> <br />Pro~,.perty Tax Lot No,; <br /> <br />Lot~ <br /> / <br /> <br />Zone; Map: <br /> <br />Irreg. Lot: Corner: <br /> ~/~ <br /> <br />Fleet SiC' Zone; <br /> ~7 <br /> <br />Block: <br /> ! <br /> <br />Total # Spaces: <br /> <br />Contractor Business Name and No,; <br /> <br />Architect/Engineer: <br /> 5-d-L F <br /> <br />Phone: <br /> <br />Phone; <br /> ~/~ <br /> <br />Address: <br /> , <br /> <br />Type of Permit: <br /> <br />New: ~ Addition: [] Demo: <br />Alter: E~ Relocation; [] Otc. Chg.: <br /> <br />Height of Building: ~ No, Stories: <br /> <br />Mobile Home Mobile Home <br />Width: j/iDc Length: <br /> <br />Sq. Pt, Main Floor: <br /> <br /># Bedrooms: <br /> / <br /> <br /> Proposed Septic InStallation; <br /> Previous Bite Evaluation <br /> <br />.. ~pe of System', .3'~7"',4~/I)~CUP <br /> <br />Test Holes Reedy: <br /> <br />Will cai[ when holes ready; <br /> <br />Proposed Bedrooms: <br /> <br />Existing Septic System: <br /> Existing. Tan~ <br /> Existing Drainfleld Lon~th: <br /> Type of System; <br /> Date Tank Pamped: <br /> <br />Existing Bedrooms: <br /> <br />[ am 13erformlng work on a Property I own or occupy, <br /> <br />Other <br /> <br />[] Tech, <br /> <br />[] Review: <br /> (I <br /> 'S~. ~t, 2~d/Fleor: <br /> <br /> Occupancy: <br /> <br />Use of Building: RES ~ <br /> <br />Sq. Ft, Garage: Other; <br /> ~t/~ <br /> <br />Occupant Load: <br /> <br /> Water Supply: <br />yalustior~: $~0 O <br />Mobile Home Fee: ~ <br /> <br />Fleet Surcharge: <br /> <br />Zoning Surcharge; <br />State Surcharge; ~,-~, <br /> <br />Plans Check Fee; <br /> <br />Site Ewluation Fee: ~-' <br /> <br />Septic Permit Fee: /~ <br /> <br />DEQ Surcharge: <br /> <br />Technical Review Fee: <br /> <br />SIGNATURE OF APPLICANT: ~.~~ <br />OTHER PERMITS REQUIRED BY THIB DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br />Reinspection Fee: <br /> <br />Investigation Fee: <br /> <br />City Fee: <br /> <br />TOTAL FEE; <br /> <br />RECEIPT NO,: <br /> <br /> <br />