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~,11 ~ R O iC(~NTY BUILDING iNSPECTION <br />Received By ,/2 ' ~¢ ' <br />City '~'~ I ~ i ! ~n~or Bldg. No, 225 <br />Zoning Validation ~ ~ , '-~2,0 HI,. St.t NB <br /> <br />Property Owner <br /> <br />BUILt~i~'E~ :~E~'~'~)ME ~ SEPTIC~ PERMIT APPLICATION <br /> Phone r Mailing Address:: <br /> / <br /> <br />Job Address <br /> <br />SubdiVision <br /> <br />Mobile Home Park <br /> <br />Site NO <br /> <br />Property Tax Lot No:: <br /> <br />Lot <br /> <br />Sp,, #;: <br /> <br />etback Re~q u~r_emen~ts:: <br /> ~-~-Rear:: ~ <br /> <br />Cross Street <br /> <br />Fleet S/C Zone:: <br /> <br />Block <br /> <br />Total # Spaces <br /> <br />Section Township:: <br />LOt Width LOt Depth:: <br /> <br />Range <br /> <br />Irreg Lot <br /> <br />Map <br /> <br />Corner <br /> <br />IContractor Business Name and NO:: <br /> <br />Phone Address <br />Phone:: <br /> <br />Address <br /> <br />Type of Permit__1 :: Tach <br />r215 i;')~ t ~-}/~ ~Alter Revi~ <br />Height of Building <br /> <br />Sq Ft 2nd Floor <br /> <br />[] Addition:: ~] Demo <br />[] Relocation [] Ccc Chg <br /> <br /> N~II S;t~-r'ies Sq, Pt, Main Floor <br /> <br /> Mobile Home # Bedrooms <br /> Length <br /> <br />Use of Building;: <br /> <br />Sq Fl Garage <br />Occupant Load <br /> <br /> I RES E3 <br /> <br />Other <br /> <br />Mobile Home Occupancy Water Supply <br />Width:: <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br />Type of <br /> Test Holes Ready <br /> <br /> Will call when, holes ready <br />Existing Septic System <br /> Existin9 T~nk Size '"7 <br /> ~xli?ting Drainfield Length <br /> <br />_ Type of System <br />Date Tank Pumped Exiating Bedrooms:: <br /> <br />Proposed Bedrooms <br /> <br /> builder <br /> <br /> ) Other <br /> <br />OTHER PERMITS REQUIRED DY THIS DEPT.: PLUMBIH6, MECHANICAL, ELECTRICAL <br /> <br />Valuation $ ...... <br /> <br />Sldg Fee $. <br />Mobile Home Fee l ........ <br />Fleet Surcharge <br />Zoning Surcharge:: <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee "7~:~ · ~ © <br />DEQ Surcharge:: .~. ~ O <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee:; <br />City Fee:: .... <br />TOTAL FEE ~D. O~ <br />RECEIPT NO:: '~ ('~ 4~ <br /> <br /> <br />