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City Setback Requirements~. BUILDING ~[~l~p~Bb I ~=.HC ~ ~U~ .... -~-~ Pr°per'wharf .~ I Phone; ] Ma~ Addres3~ I)~ ~ [) ~ ~" ~ ~ ~ ~ ~r ~ Property Tax ~ No.: Fleet S/C Zone; Mobile Homo Perk: . / ~ Sp. ¢: ~ / Total ¢ S~: / I Lot Width; Lot Depth; I Acre,~ I Irreg. dot;'~ Corne~'/ ,1,43 '7 COntractor Business Name and NO~ Architect/Engineer: Phone: Phone; Type of Permit; New; ~"'" Addition: [] Demo: ~d Tach. '~"~ Alter; [] Relocation: [~ Occ, Chg,; E] Review'. [] Neigh} of Suildip. g; ,&¢- No, Stories: Sq. Pt. Main Floor: Bq. Pt, 2nd Floor: _,_(¢ ¢- ftc- / Mobile Home Mobile Home # Bedrooms: Occupancy: Width'. Lengtht Proposed Septic Installation: Previous Site Evaluation ,¢; of System: ~ Test Holes Reed)/; --V~ill call wh,.en holes ready: Existing Septic System; Existing Tank Size; Proposed Bedrooms: Existlr,g Draintie~d Length: _ Type of System; Date Tank Pumped: Existing Bedrooms; I have read this application in its entirety and certify that the stated information is ( ) t am a registered builder OR ( ) the authorized representative of a registered buyer. ( ~' ) The work will be performed by a registered bullde: ( ) Other .__ $1GNATkJR)~ OF APPLICANT" ~O" ~' V OTHER PERMITS REQUIRED I~Y THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL jf.,,.._/,~ ..... Address; ~"~,~ Address; ~ / - Use of Buildin : Sq, Ft, Garage: Occupant Load: Valuation: COM E~ Other; Bldg. Fee; Mobile Home Fee: Fleet Surcharge: Zoning Surcharge'. DEQ Surcharge: C~ Fee: RECEIPT NO,;