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- ..... _ : .... _ ~ <br /> ~dOBILE <br />Job Addmss:: No <br /> <br /> Cross Street:: C~ 72 <br /> <br />Subdivision ~ ~)O LOt:: /~ 8look ~ <br /> ~ ~:: Total ~ S~aces <br /> <br />Section. Township Range:: Map:: <br /> / <br /> 7~1~ ~ P 5-~ <br />Lot Width Lot Depth Aeree Lot:; Corner:; <br /> <br />Contractor 8ueinee$ ~m~,m'fd NO <br /> <br />Architect Engineer S <br /> <br />Phone:: <br /> <br />Address:: <br /> <br />, Type of Permit New [~ Addition [] Demo [] Teoh <br />I'~-"~,~,,~ Alter [] Relocation:: [] Ocs [] Review:: <br /> <br /> Height of Building ~ ~ No.. S*O,~O*:: I Sq. Ft Main Floor [ Sq F~FlooK:: <br /> ,, ,I Occupanoy:: <br /> Mobile H~e (/ Mobi~ ~me I ¢ Bedrooms:; <br /> Width F ~A~~ <br /> <br />Use ~f Building , ] RES <br /> <br />Other. <br /> <br />Valuation:; <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation #' <br /> <br />Test Holes Reedy:: <br />Will call when hole~. [e_ady:: <br /> System <br />Existing Tank Size <br /> <br />Proppsed Bedrooms <br /> <br /> Drainfield Length;; <br /> <br />Date Tank Pumped Existing Bedrooms:: <br /> <br /> builder <br /> <br />(t,~ I agree to bald according to the Sub~t~ed/olcns and 8pec. cj~t, ions~w$ of <br /> <br />MC 15-6 <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Cheek Fee <br />Site Evaluation Fee:: <br />Septic Permit Fee <br />BEQ Surcharge <br />Technical Review Fee:: <br />Reinspection Fee <br />Investigation Fee:: <br />City Fee <br /> <br />TOTAL FBE:: <br />RECEIPT NO <br /> <br /> <br />