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Received By: .4!, ':iM~AR!_O NT~' BUILDING INSPECTION <br />ZC~nYing Va/idsflom 220 High Street NE <br /> <br />Date: ~_..r:~/_.._~ ; Phane 588-5147 <br /> BUI,kDIN~MOBILE[ <br /> Pro~ty Owrl~.: Phone: <br /> <br />HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Jo~ Address; <br /> <br />S~/ivisiom / , <br />Mobile Home Park; <br /> <br />Section: <br /> <br />Lot Width: <br /> <br />· ' Township; Range: <br /> <br /> Let Depth; Acres: <br /> //¢, 3'6 <br /> <br />Mailing Address; . <br /> Cross Street,~ " <br /> <br />Site NO,: <br /> <br />Property Tax LOt No.: <br /> <br />Sp. #: Total # Spaces; <br /> <br />CorM <br /> <br />iC~n~actor B~,s,~iness Name and No.: <br />Architect/ ineer; <br /> <br />Type of Permit: <br /> <br />Height of Building: <br /> <br />Mobile Rome <br />Width; <br /> <br /> ~ Addition: ~ Demo: <br /> ~ Relocatkm: ~ OCt. Chg.: <br />"NO. Stories:// Sq,,///~cFt, Meln Floor: <br />Mobile Home # Bedrooms; <br />Length; <br /> <br />Tach. <br /> <br />Review: <br /> <br />Sq. Fi, 2ad Floor: <br />Occupancy; <br /> <br /> Proposed Septic Installation; <br /> Previous Site Evaluation #: <br /> <br />...... Ty~? _e _.o._f System; <br />Test Holes Ready: <br />Will call when holes ready: Proposed Bedrooms; <br /> <br />Existing Septic System; <br />ExJstJn~ Tank <br /> <br />Existing Drainfield Length: <br />Type of <br />Date Tank Pumped: Existing Bedrooms; <br /> <br />OTHER PERMIT~ REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building; J RES ~ ~ <br /> I °°' ° <br />SCi.,~Ft' Garage; ~ther; ' -- <br /> <br /> Valuation: $ ~ O~ <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 />Reinspectlon Fee; <br />Investigation Fee; <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO,; <br /> <br />s <br /> <br /> <br />