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e ed By Z>.i~,,Y~'&~ ' ~f I~O~ (~O~N~Y ~JtLDING INSPECTION ~~t~ <br />ZoningVaiJdation __/J~ f;l~ ~ 1~Z0H~StmetNE %SI/l Ihront /~/ /Rear <br />~/ , - , d*/ Left Right <br /> <br /> BUILDING ¢ ~ ~'~ ~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Property Owner, <br />Job Address <br /> <br />F~-e~t §/C Zone <br /> <br />Block <br /> <br />Tote~ #Spa, ce,s <br /> <br /> Phone:: <br /> <br /> , . <br /> , /. ', ~ c -~.~ ~ 7-bOz <br /> /... <br />Section ] Township ~ Range <br /> <br />. /// <br /> <br />Addition <br /> <br /> Phone <br /> <br /> Phone, <br />'~.,I,,d ..~ <br /> <br />Address <br /> <br /> Demo I~ Tach Use of I~uilding RES E~--- <br />IJ Relocation rq Ccc Chg [] Review [] ~/')/¢/~Pd¥'1~ '~-?'¢r~E COM b~ <br /> <br /> No Stories Sq Ft Main Floor Sq Ft 2nd ~loor:: <br /> / <br /> <br />Mobile Home <br />Length <br /> <br /># Bedrooms <br /> <br />Occupancy <br /> <br />Sq Ft Garage Other <br />Occupant Load Water Supply <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Type of System <br /> <br /> Tes[ Holes Ready,, <br /> Will call when holes ready ____Proposed Bedrooms;: <br /> Existing Septic System <br /> Exisbn9 Tank Size <br /> <br /> _ E×isfin_9 ._~rainfield Lgngth <br /> Type of System <br /> Date Tank Pumped Existing Bedrooms;' -- <br /> //t~eve road this 8ppllcabon in its entlroty and comfy that the stated information is true and correct to the host of my knowledge <br /> I am performing ~rk On e property I own or occupy <br /> ~ ~m a ro¢lstere¢ builder OR f ) the authorized mpresontatzPe of 8 registered <br /> budder <br /> <br />f ) Other <br /> <br /> -: , , C RICAL <br /> <br />Varuatien $ t>~' ~ (~ <br /> <br /> Bldg Fee:: <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br />Site Evaluslion Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br /> <br />Reinspectien Fee:: <br /> <br />Investigation Fee <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br />,9:?. _ <br /> <br /> <br />