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" " '~h ~ <br /> BUILDING ~ MOBILE "O"E ~ SEPTIC ~/~ <br />r-~ro~: ....... ~ P~one ] Mailing Address:: <br />/Job ~d~re~s Site NO:: Street <br /> <br />Subdivision <br /> <br />M~¢/,~/.fie H~o~m~e Perk:: <br />So.ion ~ Township <br /> <br />Lot Width / ~'~ <br /> <br />Property Tax Lot No:: Fleet S/C Zone <br />Lot I~ock <br /> <br />sp¢ /¢¢_~ Total # Spaces <br /> <br />Phone ] Address <br /> <br /> Demo <br /> y/.¢~ ¢" r ¢ j Alter LJ Relocation [] Ccc Chg. <br /> ~/~///¢ .... <br /> Height of,~/Building::/ INo StOI-z [ <br /> ie/s Sq Pt, Main Floor <br /> <br />~bi~'e Home --'1' M~bile Ho~e # Bedrooms <br /> Width <br /> ~ Length <br /> <br />Tech <br />Review [] <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Occupancy <br /> <br />Proposed Septic installation:: <br />Previous Site Evaluetien # <br /> <br />Type of S_y_stem <br /> <br />Test Holes Ready.__ <br />Wil~ call when holes reedy <br /> <br /> Existing Septic System <br />--..~xistin~ Tank Size <br /> Existing Drainfield Length <br /> <br />Proposed Bedrooms <br /> <br />Type of ~ystem <br />Date Tank Pumped <br /> <br />~ I agree to build accarding to tho submitted plans a~ecifloations the la,eof <br /> <br />OTHER PERMITS REQUIRED B~ YHIS DEI~'E'-~I.UMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building:: 1 RES <br />~'~I¢.,_~ ~.~ COM <br />Sq Ft Garage Other <br /> <br />Occupant Load <br /> <br />Water Supply <br /> <br />Valuation;: <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee:: <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br />Site EvaluaSon Fee:: <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee:: <br />Reinspection Fee <br />Investigation Fee <br /> <br />City Fee <br /> <br />TOTAL FEE:: <br />RECEIPT NO <br /> <br /> <br />