|
,J.?~.Addre$~, ,.,: ........ . Site NO.: ' Cro~ Street ', /~' '
<br />Pumbng'lnsta er , ' Phone' ' ' ~,,~,~
<br />~, ,,.,,~- ,~ ~,~ ,~. ,~.~,~,~ ~,~-~ ~b~,~,~,l ~~ ~,:,~., ~-~/~, ~,~Z~,..~ U,~ ~. ,.
<br />' ' ' ~1'15~ ............. "' ...............
<br />,,Residential:= ~ . ~ New: ~ · A~diti~g; Q O~up~ncy Useof~uilding:: :.
<br />
<br /> ~ ~ ,~.~: ~ , ',
<br /> ,- 'Newoon~truCt~n e~hfxtum,~. ~ ~, ~ ~;~; '~ '~ '~ .....
<br /> , , ....... ~ ........... ,, . ~ , .$,,.9,00.,
<br /> < ' ' "'~ '""~ ~ "~ ....... '' +' ..... ' ' '~" ' 4;50
<br /> , .... ,.,, ~ ,,. . ..:'-~-
<br />
<br /> ~" "& ' '~ ~0 .....
<br /> . ,Fo~a~dlton~lOOfeet ~' '~. ~ ~;~ ~, ~ ~:
<br /> 'Sewe?Se~l~LInes'' ., ' ..... "' ," ~ ' , , .,, , .....,. , 'f,,~,,, .
<br />, PJrst4OO~et~rfrac~on thereof ~ , , ~ · ..... :' .... 3o'.
<br />Addtp~ ~Oefeet · ., r., .,,
<br />. ..... ~ ........... ~,~ ............................. · ....... ' , ,~, 1500 ·
<br />'$ e ' , ~ ...... ~ . ....
<br />Other (~ ~r OSPSO and Bull~ing Offioial) .
<br />On-8 te ~o~n o~ Bev ew (app y at M~r on Co~n~ Qn y) ',
<br />w~th the md[~at~d.~ee ...... ~. ~,,~ ~ ~~¢~
<br /> , . ' ~,..~ .... ., ,,~ ~.~;~ '~' ' ~ .;~., ~. ...... .'~ .~: ..... , .TOT~,
<br />
<br />MC 15-45
<br />Re~ 12/87
<br />
<br />
<br />
|