Loading...
HomeMy WebLinkAboutPermit Septic Tank 1972-5-4 ~7 :'-'. '. '. '.' ~~-=~;;f~-lR\ll\\~ 0' ~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 IJ L a k e..L --r. CK a L{/J1 D tJ d -, C9~TRAC~Ot I .1/ .' V. . MAILING ADDRE.SS '. ~ ' U Q;V . ~~L-- -e..;e - 9'..3.3 2.0 ' :3 7 ~..:vI S,A ~ :;~TYlCA3N-(JCU;;~~E~~-- .- - .. ~ ~r~ "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 " ~ :2 3 ..L..l-tt- ~ .,J., I ,-I f) r:> ~ /(~, . . DESC~ON PROPERTY IF ANY C;)' / LEGAL ACCESS TO PROPERTY L. ROAD NAME OR # /3,J h.'37~~ ~-'~ 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 c;)(2.~~~) (/)~/ ~ '~ - ( / ,0'~ ~o~ ..,..., - /7, APPLICANT NAME AND Connect to Existing . '/J ,TYPE CONSTRUCTION ,d~~ (~0lJfJ-) 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 Cl) 6> ; :z.-- d6.; '!clJr.( " / (/' UmJill 'If ~'OjJ::U1ft 'Ii\r-n..,,(f~~g! j\~l~ ~~lN\ft ,~OWtl~ 8-; tlIJlT l!D'lotltrUl!:. 1t.l!=tiI). 11\1& 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 ^ ~ k.v~b4~ ..., FEE RECEIVED BY ~. 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- //" 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 (/ IV J. ~n--: 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. (- ~ V' {/ u- {~ . b(rections to Find Property: . U :L(;,C3 t:?~,d}~_ ~ "'/ / COPY 1 - OFFICE COpy 2 - JOURNAL COPY 3 - AUDIT OR SQUARE FEET I / ~/ REAR YARD PUBLIC UTll. 7MENT USE. ClASSIFICATION ., k' V /h!Jd~1&l r~r~ 7t~ {! / Form # C55-12 ~Nl(OU~~Y )ptCAl P~Mfi ~~