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,..,..,..,. "- .:: . L¢tor,,one'ae' I,-et, . <br />~ete: 0'~'.,,,/-~' / __ ~,~,.., /' '~':,.; %,,r~.e ~.~a7 I S~de: ..q' I s~aa; .P' ' <br /> /~'~? ~';/UJ~ £b~ Cod~-A-Phone 4:30 P.M. - 8;00 A.M, ~" <br /> ~U,LO~NG ~4~HO=E [] SEPTIC [] ~n* ^~uc~o. <br /> -~-'~i ...... , .~,~'~(,~tl~,~, Phone: M 'ling A dress'. . .~. '"-~ <br /> <br /> ~-~ ....· Rite NO.: Or~ Street: / <br /> <br /> ~¢~ 8 ~,~u~l/~ ~~ ~ - <br /> <br />Moblle Home Park: <br /> <br />Lot Wiglh: ~ ~ B~p~-; ] Acres: <br /> <br />Sp. <br /> <br />I Archit§cJ/~nglneer: ._..-__ / Phone: ' I Addte'e's: <br /> <br />Type of ~ermit: <br /> <br />Height of <br /> <br />Mobile Home <br />Width: <br /> <br />-'New; [~/ ' Additionr [~ Tach. <br />Alter; ~ Relocation: [] Review: <br /> <br /> Occ. Chg.; [] <br /> <br />No. Stories; ~ Sq, Pt, Main Floor; <br /> / 'l <br />Mobile Home # Bedrooms; <br />Length; <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Occupancy; <br /> <br />Sq. Ft,~ 'lhther: ~ <br /> <br /> Va~uat~oJ: '~-P--SgFS=¢.- ~ 0 <br /> <br />Proposed Septic Installation; <br /> Previous Site Evaluation #: <br /> Type of System: <br /> <br />Test Holes Ready; <br />Will call when holes reedy: <br /> <br />Proposed Bedrooms: <br /> <br /> Existing Septic System: <br /> <br />__ Existin¢ Tank Size: <br /> Existing Drainfield Length: <br /> <br />Type of System: <br /> <br />Dm9 ~enk Pumped: __ <br /> <br />Existing Bedrooms: <br /> <br /> Other .... <br /> I ~gree to build according to th e ~_.,.u~efnitled pill/an d/.4pecifi¢~tions, the laws <br /> <br />OTt-IER PERMITS REQUIRED BY THIS DEPT.: PLUNIBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg, Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning S~tch&rge: <br />State Surcharge; <br />Plans Check Fee: <br />Site Evaluation Feet <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Techni~cal Review Fee: <br />ReinspectJen Fee: <br />Investigation Fee: <br />City Feet <br /> <br />TOTAL FEE; <br />R~=CEIPT NO.: <br /> <br /> IZ~. 5Z <br />Z~ <br /> <br /> <br />