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Pr'~per t wner, <br /> <br />' Phorte 58s.5147 <br />~ ,\ .,'OouNT~ <br /> <br />Job Addrees <br /> <br />St~divisien - <br /> <br />Mo~ile Home Park:: <br /> <br />Site <br /> <br />Property Tax LOt No <br /> <br />Sp ,,¢ <br /> <br />Lot ~th I -~i-D~Kpth <br /> 9o ¢4, L i..~ ~o <br /> <br />Setback Requirements <br /> <br />Right <br />Side:: ~"'"' <br /> <br />[PPLICATION <br /> <br />/,¢,~/ ,¢~,~u///¢. ¢¢3 <br /> <br />Cros¢ Street:: <br /> <br />Fleet S/C Zone <br /> <br />BlOCk:: <br /> / <br />Total ¢~ Spices <br /> <br />Phone <br /> <br /> pe of Permit:: J New:: [[2.~'' Addition:: rq Demo:: L~ Tach <br /> <br />Height of Building ~['Stories j Sq, Ft Main Floor:; Sq Ft 2nd Floor <br /> <br /> / ~lobile Homo # Bedrooms:: Occupeacy; <br /> I Length <br /> <br />Mobile Home <br />Width <br /> <br />['Pr~peee~ Septic Inst~ll&tion <br /> Previous Site Evaluation #:: <br />I- ~-sy'~ <br />I Test Holes Ready <br /> <br />IWill c~all when holes ready <br /> Existing Septic System <br /> E~tSb~g Tank ~,ize <br /> Existin9 Dtainfield Length <br /> Type of S~;tem <br /> <br />Proposed Bedrooms <br /> <br />Exist?.g Bed_rooms <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br /> <br />Occupant Load <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />( I Other <br />( ~ I agree to build according to the submit'ed glans and specifications the laws of <br /> <br />OTHER PERMITS REQUIRED IBy THIS DEPT,:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br /> COM ~ <br /> <br />Other <br /> <br />Water Supply <br /> <br /> $ <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 Cee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />