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' r-~- ,~ M~.':tlOI~I~OUNTY BUILDING INSPECTION <br />Zoning V~l~a~~ ~ H~ ~ NE <br /> <br /> BUILDING [] MOBILE HOME [] SEPTIC [~ PERMIT APPLICATION <br /> <br />Job ~dr~s~ ~ ~,, <br /> <br />Subdivision! <br /> <br /> Mob,e Nome Park: <br /> <br />Lot W]dtl3; LOf <br />., /o~ ,,,~ <br /> <br />~rty ~ax L~ No,: ........ <br /> <br />Block; <br /> <br />Irreg. Lot;; <br /> <br />Contractor ~slness Ne, me and NOJ I :: <br /> <br /> Type of Pa~mtt; I New; ~ ,~ditk~t: []" ~: ~ ' Tach. <br />.~?p'"S"/~__,. ~ Al~r: ~ ~ati~: ~ ~,, ~hg,; IJ ~i~:: ~ <br />~. ~~.. <br /> <br />~ ~ ~ ~ile ~ · ~: ~pa~ <br />W~: J Length: <br /> <br /> F~'evlcus Site EvaJuatio~l <br />.~.Type of Sy~m:: <br />Test Holes R~ <br />__~jll ~11 when ~ <br />Exl~lng ~ePflC <br /> EX~ ~nk Size: <br /> <br /> ~e o~ S~tem: <br /> <br />Date Tank Pumped: <br /> <br />Exislintj Dedrooms: <br /> <br />Use ¢~ ~u~ng: <br /> <br />~:1, Ft. Gexage: <br /> <br />OTHER PERIIR/T~; REQUIRED ~ THIS[ DEP'E: PLUMBING, MECHANICAL, FJ-EClRICAL <br />tAc 15,A <br />Rev. 12/87 <br /> <br /> RES ~ <br /> <br /> COM ~ <br /> <br />Other: <br /> <br />WatGr SUpI~y' <br /> <br />Mo~le Home <br /> <br />Zonirt~ Surcharge: <br /> <br />Plans C~k F~: <br /> <br />DEQ ~rc~; <br />T~ni~t <br /> <br />Relsspe~--flon Fee; <br /> <br />Investig~O~ Fee;: <br /> <br />City Fee:: <br /> <br />TOT,~L FEE;; <br /> <br />RECEIPT NC)-: <br /> <br /> <br />