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· Phone 588-5147 <br />00 !J l~;~^-P,o.~ s=ss ,.=... s=oo <br /> SEPTIC <br /> <br />Phone;; <br /> <br /> Cit__y _Setback R_esutreme~nts <br /> <br /> Front ~ ~' ! Rear:: ~.~-./ <br /> Tt' ,/ / Ri -ht ..... <br /> /Side ~)~ <br /> <br /> PERMIT APPLICATION <br /> <br />ing Address:: <br /> <br /> Cross ~t/eet <br /> <br />y Owner~_~., <br /> <br />Job Address <br /> <br />Mobile Home Park:: <br /> <br />Site No, <br /> <br />Property Tax Lot No;: <br /> <br />Let:: <br /> <br />Sp ¢ <br /> <br />Fleet S¢0 Zohe <br /> <br />Block <br /> <br />Total ¢ Spaces:: <br /> <br />Section Town~p~ Ra~::/~.,~ Zone:: Map:: <br />Lot Width:: Lot Depth Acres;: Irreg,, Lot Corn~, <br /> <br />Con r._~tor Business Name and No,:; <br />Architect/Engineer . Phone <br /> <br />,/ <br /> <br />Type of Permit:: New:: ~ Addition [] Demo [] Tach <br /> <br />Height of Building:; No Stories Sq Ft Main Floor;: Sq, Ft 2nd Floor:: <br /> <br />Mobile Home <br />Width <br /> <br />Mobile Home <br />Length <br /> <br />,# Bedrooms <br /> <br />Occupancy <br /> <br />"U-S% of Building I RES ~ <br /> eom <br /> <br /> Sq Ft Garage T <br /> Occupant Load [ W~?i_~p. ly <br /> Valuation $/~__,~ d <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation '¢ <br />Type of System:; <br />Test Holes Ready:; <br />Will call when holes ready:: Proposed Bedrooms:: <br /> <br />Existing Septic System <br />Existing Tank Size:: <br /> <br />_ Existing D__ra_~nfleld Len_~[th <br />Type of System <br />Date Tank Pumped Existing Bedrooms <br /> <br /> I I~ave read this application in its entirety and certify that the stated tr~lor magon Is <br /> true end correct to the best of my knowledge <br /> <br /> t am a registered bu~tder OR ( ~he authorized representative of a registered <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Mobile Home Fee ..... <br />Fleet Su~harge -~, ~.~' <br />Zoning Sumharge <br />State Surcharge:: --~ ~ <br />Plans Check Fee /3¢ ~ ~ <br />Sits Evaluation Fee <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Reinspeotion Fee <br /> <br />Investigation Fee <br />City Fee /~, ~-~ --- <br />· oT, <br /> <br />REOEIPT <br /> NO <br /> <br /> <br />