HomeMy WebLinkAboutPermit Application 1976-8-10
NOTE:
___ . PERMIT iF/lJJI-~?3-7~
NO PERMIT WWBE ISSUED UNTIL THIS APPLICAT .HAS BEEN APPROVED
APPLICATION FOR:
CONSTRUCTION c::=J
MOBILE HOME ~
PLAN REVIEW c:::J
CHANGE OF OCCUPANCY c:::J
c6 OWNER Ma,..., '1.'11.. .l3<;>a...~ /755 Gu.~.:T,'s !7"/e..,,, 97'-10} 'f((,s-- 00 'ff'f
Name Address City Zip Phone
c=J CONTRACTOR
Name Address City Zip Phone
O.S. REG. II
ACCESS TO PROPERTY (Road Name) ~ttl1'1 e_ ~ 1'\'" R Da..,J
Existing Structures on Property: N f"j ne-
/.
Tax Lot _< 7 D 0 Code d'~ 2.. 2- Census Tract
PtO~y ACteage,J~ 3 / Width_Depth
3':l3b /7
PropertyLocation-Address!Directions: S,C ""nt-ne..- or:- J}~~h10H ciS' Fe,..,. V fi!,/ and
G;a.11'I e Fa.... I'n R.J L /J ,J '
3' S 3 S- ~ _.p f;~! !<t?~)' .?: ~~ q-J~D I
Below for Office Use OnlvXXXXXXXXXX . xxxxxxxxxxxx~xxxxxxxxxxxx~_
~,- ,} L /' / Sq, Ft. /I I/)Iedtooms Valuation
/' /Z.?.//' _ L/'h A4L/ A; . 11.:l .
- . - d
.-!k-aZ;fAf ~ (~~fJ)"
'I'W'p.
/'7
,
Range .3
Section
/<
Subdivision
Lot
Block
FEES:
PLUMBING:
Installed by
SEWAGE DISPOSAL:
Site Inspection u.7A'...,':;-7S-
WATER SUPPLY:
Well Spring _ Other
Community ,
stem c::=J or New System Required .~
-- Name of Community or Public System ~
er c:::J,lli Other c:::J Name
PLUMBING FEES:
Fixtur:~, s Sewage
!J Connection A
\ 'I
\ I'
"
I'
i
,
1
,
I'
~ I
Min, Septic la~kr~acitl "Ii""" , ;DrainUeIj R~ff~4t /(70 . Maximum Dep~_?.6
.!J'/J.,Hf}eld mho. JcYA~:.;T; . fflO/:u./t> hl)~ Sfu<'.
Bldg.
Plumbing
$/, tJO
__L./ .:l..
.:? .;; Iff2-
Water
Connection
;;2,
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
:'30, ern
o CASH
~ CHECK
~~~RNISHED FACILITY PERMIT
~ YES c::::J NO c:::J YES~NO
Signature of APPIicant;~<?4(;'",C~ 'J!ad,
Fee Received BYS/~ Date: -9-7t::
TOTAL
ll3.ff. / 2-
~ ~c.66,
Type of Construction
Group
Fire Zone
Use Classification
BIdg Setbacks - from Center of Road Right of Way:
F ~ I Sid I /5 ' ., . - .
ront ~ e nt. ....___ _.._____OG4!>
Rear ~.
Zone ~T 't.O
~q-7(_
, ,
C55-12
DATE:
1~:JJ;,<~8jfh ~~
COUN~1MENT OF ENVIRONMENTAL MANAGEMENT
DATE:
-;t- /CJ-7 ~
LANE