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BUILDING L~ MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />ICity Setback Requir_e_ments <br /> Front c~ / Rear:: .~- / <br /> <br /> Left / Right <br /> Side;: .,~-- Side:: 5 / <br /> <br />Proper t~ Owner :: ,.-.,~ . <br /> <br />Job Address <br /> <br />Mobile Home Park <br /> <br />Section <br /> <br />Lot Width <br /> <br /> Township Range <br /> <br />Lot Depth Acres:: <br />i <br /> <br />Phone:: M~iling Address:: <br /> <br /> Site NO:: Cross Street <br /> <br /> Property Tax Lot NO Fleet S/C Zone <br /> LOt]~ Block::~ <br /> Sp ¢ To~al ¢ Spaces <br /> <br /> Contac or Bus ness Name and No <br /> <br />~ ArchiteCt" <br /> <br />Type of Permit:: <br /> <br />New:: ~ Addition [] Demo [~ Tach <br />A)ter ~ Relocation [] Ccc Chg:: [] Review:: <br /> <br />Height of Building:: No Stories:: Sq Pt Main Floor:: Sq Ft 2nd Floor:: Sq Ft Garage <br /> <br />Mobile Home Mobile Home # Bedrooms Occupancy:: Occupant Load:: <br />Width ;: Length <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Typ_e.¢,,f. System <br /> <br />Test Holes Read~/:: <br />wirl call when boles ready Proposed Bedrooms:: <br />Existing Septic System:: <br />Exist[,n,~_ Tank Size:; <br />Existing Drainfleld Length:; <br />...... Type of System <br />Date Tank Pumped:: Existing Bedrooms <br /> <br /> I have mad this application In Its e~tirety and certify that the stated information is <br /> true and correct to tho best of my knowledge <br /> I ~rn performing work on a proper~oown or occupy <br /> I am a registered builder OF{ ("v)"tcho authorized represent8tive of e registered <br /> <br /> The work will be performed by e registered builder <br /> <br />OTHER PERMITS REQUIRED DY THIS DEPT,: PLUMDING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Use of Building:: <br /> <br /> RES <br /> <br /> I Other <br /> war r .Supply <br />Valuation $ ~;,, <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 5 <br />TOTAL FEE <br /> <br /> <br />