HomeMy WebLinkAboutPermit Septic Tank 1972-5-4
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~li'tt. \\:,~I\1I!i'lli3 fAN'E COUNTY Q,UILDING PERMIT OR MOBILE
~E~RMIT TYPE - BUILDING & ,MOBILE HOME 0
PROPERTY OWNER MAILING ADDRESS
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C9~TRAC~Ot I .1/ .' V. . MAILING ADDRE.SS '. ~ '
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"0"'" LE~Al D"C~""ON .., .,5b:;-/7:/! /.l 'v ~. L7 /N, /1 4' ,r-'/ METES & BOUNDS 0 YES
LOT - BLOCK - SUBDIV. , ~ 7I,~'~~^~~~q~ ~'I'I ~ ls? ATTACHED ~C?
TWP RANGE SEe. . ili{x LOT # CODE CENSUS TRACT
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~ /(~, . . DESC~ON PROPERTY IF ANY
C;)' / LEGAL ACCESS TO PROPERTY L. ROAD NAME OR #
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MAILING S Z WI T
() A' (./"~n.' PROPERTY I E- D H DEPTH
ADDRESS~. ae, ?7l/'~1 //5- //~
FOR MOBILE"HOME grwMlT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
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APPLICANT
NAME
AND
Connect to Existing
. '/J ,TYPE CONSTRUCTION
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HOM'" ,USE APPLICATION
PERMIT:#= (J l(7-' 7 J
PHONE
PHONE .
/Y'b-~/S-
V
AREA
Sewage System 0
SQ. FT.
or New System Req. 0
# B>EDROOMS VALUATION
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SEWAGE DISPOSAL
PUBLIC 0
BLDG.
WASTE DIS.
PLUMBING
PLAN REVIEW
PARK TRLR. .
SEPTIC ~~ OTHER 0
$. ::2.9: () n_ FEES WATER SUPPLY
PUBLlC~. OTHER
PLUMBIN<;> fEES A~u.M....
" . FIXTURES I~q'
if
PLUMBING INSTALLED BY
OWNER 0 OTHER D NAME
PLANS FURNISHED
YES~ NO 0
\./. Jl'NATUREY APPhlCANT
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..., FEE RECEIVED BY
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PERMIT # >." .' 7'
u'f -'led--
'. CASH 0 SEWER'
'CHECK ji;!/CONNECTION FEE
TOTAL
:2.9'... (;) 0
PUBLIC WATER
CONNECTION FEE
FACILITY PERMIT
YES 0 N~
DATE
0:;0.0.2-
"' DATE
66/'p.2-
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MIN. SEPTIC TANK CA.PACITY
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FiElD REQUIRED
WITH DIST. BOX: GAL
lIN. FT.
TRENCH WIDTH FT.
TYPE OF STRUCTURE L" It I ., OCCUPA~P ZONE
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BLDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY ,. '
FRONT ,/,,fJ SIDE INT. . ~ SIDE EXT. ---- REAR S--
.~AN~:~~_~_'7{ate~. PlANN.ING.. ',ttt.. S-"-;~;2BlDG. INSP.
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b(rections to Find Property: . U
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COPY 1 - OFFICE
COpy 2 - JOURNAL
COPY 3 - AUDIT
OR SQUARE FEET
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REAR YARD PUBLIC UTll. 7MENT
USE. ClASSIFICATION ., k' V
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Form # C55-12
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