HomeMy WebLinkAboutPermit Mechanical 1977-3-9
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INFORMATION SHEET
) Building Permit
( ) Site Feasibility Study for Septic Tank. Number of sites
( ) Would like to meet on site. Call (owner, etc.)
Acreage or Lot Sizc Test holes will be ready
Partitioning # ( ) Completed Subdivision
( ) Pending
APPLICANT'S NAME AND ADDRESS .:T...hr,"-.L'I lA) ;+"~""6....r c.L..n..J.-.
OWNER'S NAME AND ADDRESS, if different from applicant's .<'7 '-"...... ~..."" ('I("p,
CONTRACTOR'S NAME AND ADDRESS _~Ifl c- l(,d~' - -M.../ _ "?<./7-S9D::'
~ail permit or results of site feasi.bjlity s!!JQY,to ( ) Applicant ( ) Owner ( ) Contractor.
~ Prefer to pick up. Call 7'l7-,c:LJ.v i;l (owner, etc.) when ready.
STRUCTURES NOWON THE PROPERTy,-T"'~ L.. L.\-J..H( Ct".....J
/YIf;j/l",,~J "7'(/-'1"1 ~ V- f)~_~
,(existing or proposed well, etc. If public, name of system)
. Lot
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Phonc
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PROPOSED USE (this permit)
WATER SUPPLy~;.,d
SEWAGE DISPOSAl
e)o j -I
'1";(,5 f
(existing or proposed septic tank, etc,) S.1. 4<
PLUMBING BY
Addroec
) PROPERTY IS WITHIN ONE MILE OF CITY (
******************************************* OFFICE USE ONLY BELOW THIS LINE *******************************************
....l.. ) New Address Necessary ( ) Facility Permit Necessary
.NE J2. A., SETBACKS: Front Side Facing Street
(FROM CENTERLINE OF ROAD)
) Special Permit Area,
Minimum Elevation:
Interior Side Yard Rear
IFROM PROPERTY L1NESI
To: Planning/Building Inspector/Sanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
Permit Processing Section
Response'
CS5,12
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687,4394
nivision,-o.