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BUILDING ~ MOBILE HOME ~ SEPTIC ~/~PPLICATION <br /> <br /> Propertyo[ ~) ~::~Tax Lo~t No,; <br /> Lot; <br /> <br /> Sp, #; <br /> <br />· <br /> <br />Fleet SIC <br /> <br />Total # Spaces; <br /> <br />--~o~tracto~ Business NabS/and NO,; <br />Archltect/Engineer; <br /> <br />Phone; <br /> <br />Address; <br /> <br /> New: [~ Addition: [] Demo: [] Tach, <br />· Alter: ~] Relocation; <br /> <br /> Mobile Home /'" Mobile Home / ~/t Bedrooms; Occupancy: <br /> Length; <br /> Width: f~./~,~ , , / ~ - <br /> <br />Use of Building: <br />Sq, Ft. Garage; Other; <br /> <br />Occupant Load: <br /> Valuation: <br /> <br />RES <br /> <br />COM <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br /> <br />Test Holes Ready; <br />Will ceil when holes reedy: <br /> <br />Prope.sed Bedrooms; <br /> <br />~//) l haYe read this application in its entirety arld codify that the stated information is <br /> <br /> I am a registered builder OR ( ) tl~e authorized representative of a registered <br /> <br />Bldg, Fee: <br /> <br />Mobile Home Fee: <br />Fleet Sumharge: <br />Zoning Surcharge; <br />State Surcharge'. <br />Plans Check Fee: <br />Site Evaluation Fee'. <br />Septic Permit Fee: <br />DEC Surcharge: <br />Technical Review Fee: <br />Reinspection Fee: <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE'. <br />RECEIPT NO,: <br /> <br /> <br />