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Received By: '~'~ TY BUILDING INSPECTION ~tback Reg,?ement$: <br /> <br />Zoning Validation: ~. . ¢ ~9~ 220 Hlgh. St~t NE Front; Rear: <br /> <br />Subdivision; <br /> <br />,-Phone'. <br /> <br />Site NO.: Cross Street; <br />.,Pmpe~y Tax Lot No;;.: <br /> <br /> Mobile Home Park: <br /> <br />~n~--¢..~2~.~._~'- TownshiP:lo <br />LOt ~th: FILot Depth; / J ' ;/~ Irreg. Lot: <br /> <br />'Pleat $/C v~g.~: .......... <br />Block: ~ <br />Total ~,,/ <br /> <br />Contractor Business Name and No,; <br /> <br />Amhitect/Engineer', <br /> <br />Phone: <br /> <br />Address: <br /> <br />Address; <br /> <br />Type of Permit; / New: F~ _ Addition; [] Demo: [~ Tach. <br /> Alter'.~ Relocation; [] Ccc. Chg,; [~ Review: [] <br /> <br />.Height of Building;- <br /> <br />Mobile Home <br />Width: <br /> <br />NO. St~.~: <br /> I <br />Mobile Home <br />Length: ~ <br /> <br />Sq,~Ft. Main Floor: <br />w~ B~%s: '. <br /> <br />O¢c%ncy: ' <br /> <br />Valuation; <br /> <br /> Proposed Septic Installatiom <br /> Previous Site Evaluation ,,¢; <br /> <br />........ .T.y~,E~ of System: <br />Test Holes Readyr <br />Will call when hol?~_r_e, ad),: Proposed Bedrooms: <br />Existing Septic System: <br />Existing Tank Sba; <br /> <br />........ .E.x?n~ Drainfield Length: <br />Type of System; <br />Date T~nk Pumped; Existing Bedrooms; <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <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 />RES <br /> <br />OOM <br /> <br /> <br />