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BUILDING~ MOBILE HOME [] SEPTIC [] <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner: Phone: [ Mailing Address; ,~'~ 3 5 J'~',r/,.k,..~ 5~. ~d; <br />J~Addres,'. ~?~ ~ ~ ~ ~ SitaNo.; " <br /> <br /> ~ ~ ~ s ~', I~ ~ O ~, ~'~ ~ ~' No.: ~,~t s/c zo.~'~ .... <br />~visi~n; ................. Lot: Bloe~; <br />Mobile Home Park: Sp. ¢: Total ¢ <br />L~ Wi~:' LOt ~pth: Acres: Ir~ ~; Corner: ' <br /> Z~ I .~ / .... <br /> <br />Contractor Business Name and No,; <br /> <br />Architect/Engineer; <br /> <br />Phone: <br /> <br />Addmss; <br /> <br />Address: <br /> <br />Type of Permit; <br /> <br />New: ~ Addition; [] Demo: [] Tach. <br />Alter; [] Relocation: [] Ccc. Chg.: [] Review; [] <br /> <br />Height of Building; NO. Stories; Sq. Ft, 2nd Floor; <br /> <br />Mobile Home Occupancy: <br />Width; <br /> <br /> Sq. Ft. Main Floor: <br /> <br />Mobile Home # Bedrooms; <br />Length; <br /> <br />Use of Building: <br /> <br />Sq, Ft, Gara{~e: <br />Occupant Load; <br /> <br />Other: <br /> <br />Water Supply: <br /> <br />RES [] <br /> <br />COM [] <br /> <br />Proposed Septic Installation; <br /> Previous Site Evaluation #: <br /> Type of System; <br /> Test Holes Ready', <br /> <br />Will call when holes read~ <br /> <br />Proposed Bedrooms: <br /> <br />Existing Septic System: <br />Existin9 Tank Size: <br />_ Exls!ing Orainfield Length; <br />Type of System: <br />Date Tank Pumped: Existing Bedrooms: <br /> <br /> true and correct to the best of my knowledge, <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee; <br />Fleet Sumharge; <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Check Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DBQ Surcharge: <br />Technical Review Fee; <br />Reinspection Fee: <br />Investigation Fee; <br />City Fee; <br />TOTAL'~EE; <br /> <br />OTHER PERMIT8 REQUIRED BY THiS DEPT,: PLUMBING, MECHANICAL, t~LECTRICAL <br />MC 15-6 - '~.~,, ?..~ RECEIPT NO,: <br /> <br /> <br />