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Selem~ O~Jon 9730 <br />Zon,~g Validation ~ ff" ~ <br /> <br />~Ob Add-i~ss Site No Cross Street <br />~ 4.~~/-~ qt/~ /~/'VI J' &./¢//~.~/ Property Tax Lot Fleet S/C Zone <br /> , <br /> -~ub~ion LOt <br /> <br />-Mobile Home Park <br /> <br />Section~.~ _ '¢Owns~,~. <br />-~)i ~'idth Lot Depth <br /> .7..¢,,d/ qs". ..¢ ¢ <br /> <br />Sp .¢':: <br /> <br />Range~-/~J Zone:~,,~ Map <br />Acres Irr~cj.~t Go~¢¢ <br /> <br />Total # Spaces:: <br /> <br /> factor Business N~ilme and No <br /> <br />lArchitect Engineer <br /> <br />-'type of Permit <br /> <br />-N~ J¢/ Addition <br /> <br />Alter [] Relocation <br /> <br />Mobile Home ~obile -home <br /> <br />_' Address <br /> <br />~) Demo ~J Tach <br />[~ Oeo Chg [~ Review L~ <br /> <br /> ~q Ft Main Floor '-~q. Ft gnd Floor. <br /> <br />Use of Building ii' R~--~ <br /> <br />Sq Ft Garage <br /> <br />Occupant Load:: <br /> <br />Valuation <br /> <br /> Proposed Septic Installation <br /> Previous Site EveJu~ttion # <br /> Type of System <br />__T_e__st ~_o. les Ready <br /> Will call when holes ready <br /> <br />Existing Septic Syslem <br />_ E._x.!sfing Tank Size <br /> <br />Proposed Bedrooms <br /> <br />Existln¢ Drarnfleld Length <br /> <br />__ Bate Tsnk Pumped Existing Bedrooms <br /> <br />t ,~,/~11 h¢ve read this apphcsdon ul its entirety and ceetlfy mat Ibe stated i~formatlon I~ rue and coffee to ~o best ~f my knowledge <br /> <br />f~ I agree to b~ d according to the submi~ed plans and specifications, ho ¢~s of ~ <br /> <br />OTHER ~ER~IT~ REQUIREO 8~ THIS DEBT_:: ~LU~BING~ ~EOHANIOAL, ~ECTRIOAL <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee:: <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee:: <br />Site Evalustion Fee <br />Septic Parr'mt Fee <br />DEQ Surcharge:: <br />Technical Review Fee <br />Reinspection Fee <br />InvegIigation Fee:: <br />City Fee <br /> <br />TOTAL FEE:: <br />RECEIPT NO <br /> <br />Other <br /> <br />W~:[ Supply <br /> <br />¢0 <br /> <br /> <br />