HomeMy WebLinkAboutPermit Plumbing 1975-12-24
NOTI,::
1'1-:111-11'1' /I ~:l .
NO PICHMJ T WI LL liE ISSUI';1J UNTJ I. TillS AI'l'LICAT LON 'liAS 111':1':11 Al'l'IWVEV ~ ,7.2---i
-75'
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{( I( ~(_~,5o ~,_~~.1._. ......~"':Lf.~_.2.f./7. 9 9 ?~
Address City Zip Phone '
Z J j.1J /71?~ ; ~-; f3-&f, H 1/ _ ~ vi-f.'.'L-?- '.Yr .J{. 13 ,
Address Clty Zip Phone
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A]'I'I.I.CAT/(ltJ FOH:
CONSTRUCTION [=1
1,10111 LE lIor-IE
[~-]
I'LA!l REVIEH
r-"-I
tit
Cl
OWNER J 9....E:.~_p.
N,lmc
cu,jJv,.
CJ
n I
CONTRACTOR~
Nnmc
O,S. REG. I!
Twp.
/'7
Range
I? ~ Section
/4
Tax Lot
/~OD
Code
Census Tract
Subdivision
V\.-</
Lot
Block
Property AcrC<ls/J;. /
Width______Depth
ACCESS TO PROPERTY (Road Name)-P ~ oJ..1?LOi J~ PTlrr'f rx-d /f?O
Existing Structures on Property: :~/Dv.5f 0cJ7- 8/./,. --- i)Y'P ()€,J,.T/;...:tJc-
Property Location - Address/Directlons:_LJ (?Q din '1-1-<1 J Fe () "'7- f1f"d . -.:::ru.....?..tJ._,rJ.~ 'T"H.
_W)1/ 'fp h 0 v So ~ I'l t; .J Q t:: r~ D A.( S r '.I v -dLQ!lJJ__-U.t-ti~ l3 I) I'" '1..
-r}.llll Fro,,-r '1 ,,..c1 ,
Below fa r Of f ie e Us e anI Yx1:.XXXXXXXXxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx:\.,xxxxxxx..xx.,xxxxxxx..xxxxxxxxxxxxx
Sq. Ft, . UBedrooms Va!uation
/
/
5JJ)-C:;
~-'A.J
/
/
/
SEWAGE DISPOSAL:
Site Inspection U
WATER SUPPLY:
Well Sp'ring
Other
Corrununity
or ~~~WR('qUired 0 .
Existing Sewage Disposal System
Pub lic
llame of Community or Public System
FEES:
:J"'{
PLUHBING:
Instal~ed .by Owner
,.
PLUHBiNG FEES:
II of
/
c:::J IOther
Fixture
/
c:::J Name
Bldg.
Waste Disp.
P!umbing
Plan-Review
~
Sewage
Connection
Water
Conn ect ion
Mobile Home
U; Surcharge
~ 'CASH
\
c:::J CHECK
PlANS FURNISHED
FACILITY PERNIT
c:::J YES
Cl NO
c:::J YES
[=:J NO
TOTAL
Signature of Applicant:
rc~
q~ Drninfield Required - Linea! Feet .17() H:lximum Depth ,?h
~A1"J_ ~'V /~~~_J..2r~~
QAbvAL/ "', .A.P~~.:::r:.a-4.1'''. ____u_.,._____
Fee Received By:
Uate:.J" -1. ....---zr
MiO, Septic Tank Capacity
~:., ~1'J
~ ./~";.,/
f
_._-_._------_.~----_._----
Type of Construction
Group
Fi ro Zone
Use ClaSsification
BIdg Setbac~ t JrAm~nter of Road
Front ~ide Int,
Right of Way:
Side Exterior
Rear
Zone
PlANNING:
~.
05-11
DATE:
2. 2.-De.r',J.t.'
LANE
SANlTAT1~~ DATE:
,.y%J. ~~, /,;J.-.2<(.7r--
COUNT; ;;;PA~nIENT~NVIRONHENTAL MANAGlCflENT
BUILDING:
DATE: