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Zoning Validation ~-y ~ ~k.u ', '; <br /> <br /> ~Di~~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Front:: <br /> Left <br /> Side <br /> <br />City Setback Requirements <br /> <br />Rear <br /> <br />Right <br />Side <br /> <br />Property Owner. <br /> <br />Job Address <br /> <br />Phone:: <br /> Ma'ing Ad ress' ~ _ <br /> <br />Site No, <br /> <br />Property <br /> <br />Cross Street:: <br /> <br />O~I P'I~ ZT~ ~2~ <br />Mobile Home Perk Sp ¢ ~t8l ¢ Spaces:: <br /> <br />Section~ ZO~ Map;: <br /> <br />Lot Width:: <br /> <br />I Township Range:: <br />Lot Depth Acres <br /> <br />Irreg Lot:: <br /> <br />c°~'o <br /> <br />Contractor Bu. siness Name end No <br /> <br />Phone <br /> <br />Phone <br /> <br /> Type of Permit I New:: [~/ Addition [] Demo:: <br />~*//'~/y'~_ ~r~o/i/I Alter:: E~ Relocation [] Oc¢,Chg;: <br /> <br /> Height of Building ' ' No Stories:: Sq Ft Main Floor <br /> /¢'/ / /,¢~,¢ <br /> Mobile Home ~ Mobile Home # Bedrooms:: <br /> Width Length . , <br /> <br />[] Tach <br />[] Review <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Use of Building RES [~ <br /> COM <br /> <br />Sq Ft Garage Other <br />Occupant Load Water S, up~Iy <br /> <br /> $. ,~2~, ,.,~ <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation #:: <br /> Type of System <br /> <br />Test Holes Read~:, <br />Will call when holes ready <br /> <br />Existing Septic System <br />Existing Tank Size:: <br /> <br />.~Prgposed Bedrooms;: <br /> <br /> Existing Drainfield Length <br />_._Typ,? of System;; <br /> <br />Date Tank F~g_n~.~ed' <br /> <br />Existing Bedrooms <br /> <br />builder <br /> <br />Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15~6 <br />Rev 12/87 <br /> <br />Velcation <br /> <br />Bldg Fee:: <br /> <br />Mobile Home Fee:; <br /> <br />Fleet Surcharge <br /> <br />Zoning Surcharge <br /> <br />State Surcharge /'~, <br /> <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee:: ...... <br />Reinspection Fee:: <br />Investigation Fee <br />City Fee:: //-']- 3_,~._ <br />TOTAL FEE '~'~' <br /> "JO J/-" ~'-- ' ' ' <br />RECEIPT <br /> NO <br /> <br /> <br />