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I C!Jy Setback Requirements:: <br /> <br />Mobile Home P~rk <br /> <br />Property Tax Lot No Fleet S/C Zone <br /> <br />Lot / ~) Block i <br /> <br />Sp # <br /> <br />Total ¢! Spaces <br /> <br />Zone <br /> <br />~rreg Lot <br /> <br />Map:: <br /> <br />C,,o~racto~ B~siness Name <br /> <br />~i;~nngineer <br /> <br /> Ty,~e oL F~ermit:: '~j <br /> <br />I Mobile Home e <br />LWi,dt_h:: __ <br /> <br />New ~ - Addition <br />Alter L~ Relocation <br /> <br />Demo [~ Tach <br />Ccc Chg [~ Rewew <br /> <br />tSq FI, Main Floor <br />17 i <br /> Bedrooms <br /> <br />Sq, Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br /> <br /> ___Ty~pe of System <br /> Test Holes Heady: .... <br /> Wi(I call when holes sead~___ <br />~-E×~ Septic System <br /> <br />Existing Tank Size:: <br />Ex!sting Drainfield Length __ <br />Type of System <br /> <br />] Date ~nk Pump_ed <br /> <br />Existing Bedrooms <br /> <br /> --7"7 ' A <br />OTHER PERMITS REQt)IREO BY THIS DEFT,: PLUMBING, MECHANIC L~ EL <br /> <br />Address <br /> <br />Address:: <br /> <br />Use of Building RES ~ <br /> COM L~ <br />Sq ~...Garage:: t Other:: <br />Occupar)l Load Ware%Supply <br /> <br />--/ <br /> <br />V~.Juation <br /> <br />Btdg Fee <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge <br /> <br />Zoning Surcharge <br /> <br />State Surcharge <br /> <br />Plans Check Fee:: <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Reinspection Fee:: <br /> <br />Investigation Fee' <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br /> <br />