Laserfiche WebLink
Received By <br /> <br />C~ty Vah <br />7onfng darien <br /> <br />Date __ <br /> <br /> BUILDING INSPECTION <br /> r Bidg,, No,, 225 <br />220 High etree~ NE <br /> <br /> Phone Sgg-~147 <br /> <br />City Setback Requirements <br /> <br />Lett ~ / R~ht ~- / <br />Side~ [ Side ~ <br /> <br />Mobile Hem( <br /> <br /> . Range <br />Lot Width Acres:: <br /> <br />SEPTIC [] PERMIT APPLICATION <br /> <br />Property Tax Lo~t No <br />Lot ~ <br /> <br />Mailing Addres : ~-~,~- ' ~ <br /> Cross Street/ ~_...~/ <br /> <br /> Total ¢~S,~ <br /> <br />.r_~_usiness N~e and No <br /> <br />Phone <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of PerrrCt, <br /> <br />Mobile Home <br />Width:: <br /> <br />New:: [] Addition [] Demo:: [] <br />Alter r-~~' Relocation [] Occ Chg:: [] <br /> <br />Use of Building ~-'" RES '~ <br /> <br />Sq Ft ~a~ge <br /> <br />Occul~ant Load <br /> <br />Proposed Septic <br /> Previous Site Evaluation <br /> <br />Type of System:: <br /> <br />Test Holes Ready <br />Will O~ll when holes reedy;: <br /> <br />Tech <br /> <br />Review <br /> <br />Length <br /> <br />Proposed Bedrooms:: <br /> <br /> Existing Septic System <br />Exi~s,!,!n~9 Tank Size <br /> Existing Drainfield Length <br /> <br /> _Type of System _t_~ ~-t ,.~,-~ ~ ~/ ~- <br />_ .Date Tank Pumped / ExJstin.~ Bedrooms <br /> <br />Valuation <br /> <br />OTHER PERMITS REQUIRED BY THI~ DEPI',: pUJMBING, MECHANICAL, ELECTRICAL <br /> <br />MC 15-6 <br />Rev 12/87 <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 />Reinepeotion Fee <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br />Other:: <br /> <br />~ater S~i~ .... <br /> <br /> L¢_o_O0, % <br /> <br /> <br />