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HomeMy WebLinkAboutPermit Mechanical 1977-3-9 TRS, TI I -; - O::l, ~ "2'2. .4 A oS I "0 Job Locatio,Je;' 3 7 ~A-M e' 'FA-I'i'M (2.D. ~? ~~~~'l 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 Bloc~ ~f1 () ~." Phonc Phonp Phonp 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.