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BUILDI,~NG [] MOBILE HeMP [] <br /> <br />Job A~r~ss:: <br /> <br />Lot w~th' Lot ~pth- ~es- <br /> <br />Gode-A-Pherm 4~0 P.~- - <br /> <br /> SEPTIC <br /> <br />Meiliog Address <br /> <br />Irr~j. Lot: <br /> <br />Tax Lot No <br /> <br />Lot:: <br /> <br />Sp- #:: <br /> <br />Cross Street: <br /> <br />Fleet S/C Zone <br /> <br />Block ~ <br /> <br />Total <br /> <br />Map: <br /> <br />Corner; <br /> <br />Phone: <br /> <br />Address: <br /> <br />Type et Portal! J New ~ Demo- [] Tech <br /> <br />Mobile H~ (/ ~obile Home J ~ Bed~: <br /> <br />.~ar~. i Wat~ ~upply ~ <br /> <br />Proposed Sept~ InstAllation1 <br /> Rrevious Site E~Iu~ <br /> <br /> Tes~ H~s <br /> Wile ~11 ~n hOlo~ <br />Ex~sting Septic <br /> <br /> Exlstt~ Drainfield Length; <br /> Date T~nk Pum~ ~_ Existing B~rooms: <br /> <br /> ~ ] ~m ~m~ ~k ~ a ~o~y J OWn or ~py <br /> <br />SIGNATUR~ OF AP~ANT ~ <br /> <br />O~ER PERM.S REQUIRED ~ TH1S ~PT.; P~M~NG~ECHANt~ ELECTRICAL <br /> 15-6 <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee' <br />Fleet Surcharge <br />Zoning Surche~e <br />stere Surcharge <br />Plans Check Fee <br />Site Evaluetion Fee:: <br />Septic Permit Fee' <br />OEO Surcharge <br />Techni~l Review Fee" <br />~inspe~ion ~e <br />InvesUgation ~: <br />City ~e <br /> <br />~AL <br /> <br />RECEIPT NO" <br /> <br />4 at> <br /> <br /> <br />