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INSPECTION <br /> <br />City Setback Requirements <br /> F~o,~t //y/ Rear /~ / <br /> <br /> Left ~ / Righl ,~, <br /> Side /~ S de <br /> <br />Pro. er ty Owner <br /> <br />5~s .... <br /> <br />Subdivision <br /> <br />Phone <br /> <br />Property Tax Lot No, <br />Lot <br /> <br />PERMIT APPUCATION <br /> <br />C Zone <br /> <br />sp # ,//7,// <br /> <br />Zon e,/~,/~, Map <br />Irreg tot Corner <br /> <br /># Spaces <br /> <br />,~o~ _/2// <br /> <br />Phone:: <br /> <br />ross:: <br /> <br /> Type of Permit ~ New F'q'// Addition ~ Demo:: LJ Tach <br />~--~/¢/'"j0¢ F'/& Alter ~ Relocation ID Ocs Chg [] Review' <br /> <br />-Nei~ht//,/of Building ~ No Stories/ Sq Ft Main Floor ~q Ft 2nd Floor <br />WidthM°bile Home [ LengthM°bile Home ¢ Bedrooms ~ Occupancy <br /> <br />Proposed Seplis Instal(ation <br />Previous Site Evaluation Cf <br /> <br /> Type of .~¥stern <br /> Test Holes Ready' <br /> Will cell when holes reedy Proposed Bedrooms <br /> Existing Sepia System <br /> _ E×~stieg Tank Size <br /> _ Existing..Drsi~fie~d Length <br /> Type of .System <br /> Bate Tank Pumped Existing Bedrooms <br /> <br />OTHECv~I~Fg~IITS REQUIR~fHIS O~T.. ~M~l~a, MECHANICAL, ELECTR~CA <br /> <br /> Use of Building:: RES <br /> <br />J Sa Ft e~ra~e j Ot~r <br /> <br /> a~: LOU~ later <br /> Supply <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge:: <br /> <br />Technical Review Fee <br /> <br />Reinspeetion Fee: <br /> <br />Investigation Fee ..... <br /> <br />RECEIPT NO:: <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge <br /> <br />Zoning Surcharge <br /> <br />State Surcharge <br /> <br /> <br />