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S.J.m, 0~.o..~o~ ~. '~ <br />Date ~//~ <br /> <br /> Property Owner ~ i Phone . ~ Mailing Ad~ <br /> Job Address:: Site NO,, s Street:: <br /> <br />MePile Heine ~a~k <br /> <br />Property Tax Lot No <br /> <br />Fleet <br /> <br />Lot Block <br />Sp # Total # Spaces <br /> <br />Section <br /> <br />Lot Width <br /> <br />Township:: <br /> <br />Lot Depth <br /> <br />Range:: <br /> <br />Map:: <br /> <br />Contractor Business Name and No:: <br />Ar~l~tect¢Engineer <br /> <br />Type of Permit <br /> <br />Phone:: ~Address:: <br /> <br />New E~'~ ,~ddition [] Oeec F~ Tech <br /> <br />Use of Building <br /> <br /> Alter' [] Relocation:: [] Ccc Chg:: [] Review:: [] <br /> <br />Height of Building NO Stories Sq, Ft Main Floor Sq, Ft 2nd Floor Sq, Ft Garage:: Other <br />/ ¢ / / /1¢%¢ <br />Mobile Home Mobile Home Occupancy Occupant Load <br />Width Length <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ~' <br /> Type of System' <br /> <br />Test Holes Ready <br /> <br />Will call when holes ready <br /> <br />Proposed Bedrooms:: <br /> <br /> Existing Septic System <br /> Existing Tank Size <br /> _ Exi~!~g Drain?eld Length <br /> .... .~¢ype of Sys!(;rn <br /> Date Tank Pumped:: __,~E~!~!!ng Bedrooms <br /> / <br /> <br />( <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMPING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />'~oning Surcharge <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee:: <br />investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE:: <br />RECEIPT NO <br /> <br />RES ~ <br />COM [] <br /> <br /> <br />