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BUILDING [] <br />-~ty O,~ne-r <br /> <br /> Job Addree$ <br /> <br />Subdivision <br /> ,t}l b ¢..,,, <br />Mobile Home Park <br /> <br /> Phone 588-5147 <br /> <br /> HOME ~ SEPT~IK~BRe~CATION <br />MOBILE <br /> <br /> Phone m~iling <br /> <br /> "Sit~ ~o ~ Cross Street <br /> <br /> Property Tax LOt NO r Fleet S/C Zone <br /> <br />'Lot ~idth <br /> <br />Township <br /> <br />Lot Depth <br /> <br />Range <br /> <br />Sp l/ I Total ¢ Spaces <br /> <br /> Map:: <br />Zone <br /> <br />lrre~ Lot Corner <br />O <br /> <br />t <br /> <br />-Co~tor BL~siness Name and No <br /> <br />-Ar~itect~E~gineer <br /> <br />Phone <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of Permit <br /> <br /> · C_o~'f-, <br /> <br />Height of Building <br /> <br />New "~ Addition ~] Demo:: r~ Tach <br />Alter:: ~ Relocation:: E] Oeo Chg ~ Review;: <br /> <br />Width <br /> <br />Proposed Septic Installation <br />Type of Sfstem ~'¢¢L_}'~- ~ ~ <br /> <br />NO Stories Sq Ft Maid Floor:: Sq Ft 2nd Floor <br />Mobile Home # Bedrooms,.~ Occupancy <br />Length <br /> <br />Will call when holes ready Proposed Bedrooms <br /> <br />Existing Septic System <br />Existing Tank Size <br /> <br />Existing. Plainfield Length <br />'Type of _system <br />Dale Tank Pumped <br /> <br />Existisg Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT: pLIJMEIING~ MECHANICAL, ELECTRICAL <br /> <br />Use of Building:: <br /> <br />Sq Ft Garage <br />Occupant <br /> <br />V~luation <br /> <br />Bide Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning 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 /> <br />COM ~J <br /> <br />Other:: <br /> <br />Water Supply:: <br />$- <br /> <br /> <br />