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Property Owner <br />Job Address <br /> <br />Mobile Home Park <br /> <br />Section <br /> <br /> INSPECTION I--O-!t-y--8-e!b~'c~-~equi~'r-e--ments:: - -- 4 <br /> lSide C_~ Side O' .1 <br /> <br /> Mailing Address <br /> <br /> Site No Cross StrUt <br /> <br /> ~Pr°pertY Tax Lot~ ~'~No Fleet S/C~e <br /> Lot Block <br /> <br />Township Range: Zone ~ Map:: <br /> <br />fContra.¢!qr Business N~.m~ and No.: <br />Architect?Engineer <br /> <br />Phone <br /> <br />Address <br /> <br />Address <br /> <br />~ype of Permit~.., New [] Addition L~ Demo [] Tach Use of Building RES U <br />~ -' ¢~"/~ Alter ~ Relocation ~ Boo Obg : Review ~ <br /> <br /> Sq Ft Garage Other <br /> <br />Mobile H~me Mobile Home <br /> <br /> Proposed Septic Installation <br /> Previou~ Site Evaluation .¢ <br /> Type of System <br /> Test Holes Ready <br /> Writ o~11 when holes <br /> Existing Septic System <br /> <br /> Existin¢ Drainfleld Length <br /> Ty¢¢ of System <br /> Bate Tank Pumped Existing Bedroo~s <br /> <br />( ) Other <br /> <br /> A <br /> <br />Valuation <br /> <br />BIdg Fee:: <br /> <br />Mobile Home Pea <br />Fleet Surcharge (C~--~-,~'- <br />Zoning Surcharge <br />State Surcharge /. <br /> <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Rewew Fee T~- ..... <br />Reinspeetion Fee <br />Investigation Fee <br /> <br />RECEIPT NO <br /> <br /> <br />