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BUILDING [] MOBILE HOME [] <br /> <br />,ily ~ck~Req~!~en~en~,:: <br /> <br /> Side;: ~ [ Side; <br /> <br />jo <br /> <br />Property Tax Lot No,,,, <br /> <br />BlOck: <br /> <br />Address:; <br /> <br />~tor Busines~ Name and No.:: ..... ] Phone; <br />Architect/Engineer J Phone,, <br /> <br />Type of Permit,, j New;; ¢ Addition: ~ Oem0:: [] Tech,, <br /> <br />Height of Building <br /> <br />MObile Hom~ <br /> <br />Mobile Home <br />Length: <br /> <br />~q. Fl, Main Fl~or: <br /> <br />Bedrooms <br /> <br />Sq. Ft 2nd Floor:: <br /> <br />Occupy, ney; <br /> <br />Use of Building" <br /> <br />RES ~ <br />COM /J <br /> <br />~lq Ft,, Garage:: ~ Other:: <br /> L <br />~---~'p~'-E~d':'~-/Water SauCy <br /> <br />Propesed Septic Installation: <br /> Previous ~te E~aluation ~:; <br /> Type of ~lem: <br /> Te~ H~R~dy~ ,,~ <br /> <br />,~i$Iing Dralnf~eld Length <br /> <br />_ Typ~ of System._, <br /> O~e "Penk Pumped: <br /> <br />Exis,Jnp_ I~rOomsL ........ <br /> <br />OTHER PERMIT~ REQUIRED BY THIS DEP~,; PLUMBING, MECHANiCA~ ELECTRICAL <br /> <br /> Bldg Fee: $ .,, <br /> Mobile Home Fee <br /> ~t Sumh~rge; <br /> <br />~ Surcha~ <br /> <br />Plans C~eok ~, <br /> <br />~ite E~iuation Fee:: <br /> <br />~tic Perm~ F~: <br /> <br />DEQ Sutcherge <br /> <br />T~hn~l Revi~ <br /> <br />~in~pe~i0n <br /> <br />I~stigation ~e" <br /> <br />City ~e <br /> <br />~AL FEE, <br /> <br />RECEIPT NO <br /> <br />? .o_. <br /> <br /> <br />