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BUILDI ~,' ~(~ ~' PERMIT APPLICATION <br /> Property,~Ow,or;¢/ ~; ~9,,~" ' - Phone: Ma~ Ad,em <br /> Job Address; Site No.: Cross Street: <br /> ~7~ ~¢~Z ~*y Property Tax Lot NO.: ~leot S/O Zone: <br /> <br /> Subdivision: Block: <br /> Mobile Home ~rk; SD. ¢: Torsi ¢ Spaces: <br /> <br /> Se~ion; , Township: Range: Zo~. Map: <br /> <br />. Lot./~¢Width: / Lot¢~Dep~h: ........ Acres: Irreg.~¢~Lot: Cor~ ¢~¢.¢' ~ <br /> <br />fCe,tractor Business Name and NO.: <br />Architect/Engineer; <br /> <br />Phone; <br /> <br />Address; <br /> <br />Type of Permit; 1 New'. <br />0~/I/'...[ t~,S~ J Alter'. <br /> <br />Height of Building; <br /> <br />Mobile Home <br />Width; <br /> <br />~"*'"" ' Addition: [] Demo: [] <br /> <br />[~ Relocation: [] Ccc, Chg.: [] <br /> <br /> No. Stories: '~ Sq, Ft. Main Floor: <br /> <br /> Mobile Home # Bedroocns; <br /> Length: - <br /> <br />Tach. <br /> <br />Review; <br /> <br />Sq, FI, 2nd Floor: <br /> <br />Occupancy; <br /> <br />Use of Building; RES ~ <br /> eom [] <br />Sq. Ft. Garage; Other: <br /> <br />Occupant Load: Watery: <br /> Valuation; $ ¢'~!~ ~_'_" <br /> <br />P~oposed Septic Installation: <br /> Previous Site Evaluation #: <br /> Type of System: <br /> <br /> Test Holes Ready: <br />Will call .when holes ready: <br />Existing Septic System; <br />Existing Tank Size: <br /> <br />Proposed Bedrooms; <br /> <br />Exist!.n.g, Drainfield Len~.; <br />Type of System: <br /> <br />..... Date Tank PumRed; <br /> <br />Existing Bedrooms; , I <br /> <br />Bidg, Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharger <br />Zoning Surcharge: <br />State Surcharge; <br />Plans Check Fee: <br />Site Ewluation Fee; <br /> <br />I have read this application in its entirety end certify that the stated information is <br />true end correct to the best of my knowledge. <br />I am performing work on a property I own or o¢cup~ <br /> <br />The work will be performed by a registered builder. <br />Other <br />I agree to build according to the submitted plans end specifications, the laws ¢ <br /> <br />Septic Permit Fee: <br />DEQ Sumharge; <br />Technical Review Fee: <br />Reinspectlon Fee: <br />Investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br /> <br />