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0 - -- ~, INSPECTION <br /> <br />ZoningVelidstlon:'~,~-,~cIIF4''~ I~_\? ~ ,/ i~,~ 220 NIgh Street NE <br /> <br />City Setback Requirements; <br />Front; M.~Bear: <br /> <br />Pro~er ty Owner: <br /> <br />Job Addresg: <br /> <br />SubdMstom <br /> <br />Mobile Home Park: <br /> <br />Lot W[dth; <br /> <br />Township: Range: <br />Lot Depth: Acres: <br /> <br />Phone; Mailing Address; <br />Site No.', <br /> <br />Property Tax Lot NO.: <br /> <br />Sp. #; <br /> <br />Zone: Map: <br />Irreg. Lot: Corner: <br /> <br />Cross Street: <br /> <br />Fleet S/C Zone: <br /> <br />Block; <br /> <br />Total # Spaces: <br /> <br />Contractor Susiness Name and No.: <br /> <br />Address; <br /> <br />Architect/Engineer; Phone: Addresg; <br /> <br />Type of ;~e~rmit; J New: [] Addition: [~ Demo: <br />~.-'~' PoL,. Alter; ~ Relocation: ~ Ccc. Chg.: <br /> <br />Height of Building: ] NO, StO~Jj~S; [ Sq,I~o~Ft' Main Floor: <br />Mobile Home ]-~;~71~'"'R~ ..... ~ B~rooms; <br />Width: <br /> <br />[] Tach, <br /> <br />[] Review: [] <br /> <br />Sq, Ft. 2nd Floor; <br /> <br />Use of Building: <br /> <br />Sq, Ft, Garage; <br /> <br />Occupant Load; <br /> <br /> RES ~ <br /> COM L2J <br /> <br />Other; <br /> <br />Water Supply; <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation Ct: <br /> <br /> Test Holes Ready: <br /> Will call when holes [eady: Proposed Bedrooms: <br /> Existing Septic System; <br /> Tank Size: <br /> Drainfield Length; <br /> Type of System: <br /> Date Tank Pumped; .//"(~"~ Existing Bedrooms: <br /> <br /> I have read this application in its entirety and certify that the stated Information is <br /> <br /> I am e registered builder OR ( ) the authorized representative of a registered <br /> bulmer. <br /> <br /> Other <br /> I agree to build 8coordl~ to the submitted plans ahd specifications, the Paws of <br /> <br />g[~NATURE OF APPLIGAN , <br /> <br />OTHER PERMITS REQUIRED~IY THIS DEPT_: PLUMBING, MECHANICAL, ELECTRICAL <br />MC t5-8 <br />Rev, 1~/87 <br /> <br />Valuatlom <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee: <br />Fleet Sumharge: <br />Zoning Surcharge; <br />State Surcharge; <br />Plans Cheek Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee; <br /> <br />Reinspection Fee: <br /> <br />Investigation Fee: <br /> <br />City Fee; <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO.: <br /> <br />/oO,oo <br /> <br /> <br />