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HomeMy WebLinkAboutPermit Plumbing 1973-8-3 ---:"I LANE COUNTVtIL9/NG PERMIT OR MOBILE HOaSE APPLICATION - . '., PERMIT TYPE - BUILDING IT'" MOBILE HOME D GSC REG, # PERMIT # J {;'o 7-73 PROPERTY OWNER ~G ADOR:'?p PHONE Mlk. / f~ Pb.14q U ) (kJaX J.J,JJ .S'.f'h// 7YZ.-sz 2.0. CDNTRACTOf / .' / . MAILING ADDRESS PH-ONE SEC. TAX LOT # CODE CENSUS TRACT ~~ /00 /;'-0/ .~ S- - I <:~ n DE~BE EXISTlN~ JTR..,UCTURES ON PROPERTY IF ANY ::!.Ibz.MJ~vr lEG!l jCCESS TO PRaPtRTY - ROAD NAME O.R # qq'6,J.""J7HP7~ ra:.~) ::L~jC -4. r[J .~<G7"y.//]a - ~ PROPERTY "'SIZE-WIDTH '- "1>EPTH AREA ,1jdf .;::t;I'A.<AfL) r~ /.l...., /R/'~~',.-u J.LxjJ1t/ JJ 'Vu#4/ fIA/~O ~ /.:2-S " ~ ~AAA=+P.fJ~ /./-09. %d- <4/#) J)~, a.-llM./x:XJ../ . I ' W' - r /' J~.r..',l~. ~/, M1iMLM-. /?d~~;t;;/L~~" ~UCT~. ,/ oce AN"CV lONE - REAR YARt) V PUBLIC UTILI EASEMENT v' ...... ___ / BLDG. SETBACKS - FT. FROM eTR. OF ROAD RIGHT Of WAY USE CLASSIFICATION / FRONT SIDE INT. SIDE EXT. REAR ,;?!J/k -rr.,'):; PLANNING, Doto BLOG, INSP. ~ C ~ ~, J R' hl?:~ Directions to ~ Property: /J/;;-;".i/% n-?; aKT lJ.f/;4/IRt<'.. G-<<A~'rldA/ ,.,/ NiJ~ rlA-t:~ .d,t~C//~~ PROPERlY LOCATION..,.. INCLUDE POST OFFICE PROPERTY LEGAL DESCRIPTION LOT - BLOCK - SUBDIV. TWP RANGE / J ,,;L APPLICANT NAME AND MAILING ADDRESS 5{tff71/ "< /K, ...; FOR MOBilE HOME PERMIT ONLY Number of Bedrooms STRUCTURES TO BE BUilT THIS PERMIT ~// ~ J i?'~-7 Connect to 'Existing Sewage System 0 TYPE CONSTRUCTION SQ. FT. f.v/:C77~A. ~~~~~ P. 7~. '7"'1 -n:_fr S:'d a...., U"lkr SEWAGE DISPOSAL - PLUM,BING INSTALLE~ BY OWNER ri OTHER 0 NAME PLANS FURNISHED OTHER YES~O 0 . V- /Y' ~ o/GNATURE OF APPLICANT /' -<.'If /tf1;:ffJ~/, ~ ,. ~ F~E~~ ~ PERMIT # PUBLIC 0 BLDG.' WASTE DIS. PLUMBING PLAN REVIEW PARK TRLR. SEPTIC TANK 0 $~_... , ;lo, Q) ;}" 0 U OTHER 0 FEES WATER SUPPLY PUBLIC 0 PLUMBING FEES _ FIXTURES CASH ~ SEWER CHECK n CONNECTION FEE PUBLIC WATER CONNECTION FEE COUNTY BUILDING & SANITATION SPECIFICATIONS DRAIN FIELD REQUIRED' lIN. FT.,:;}~ TRENCH WIDT.dl,;;z... OR SQUARE FEET TOTAL 2-7_ 0 jJ MIN. .SEPTlC TA~K CAPACITY 4- ) WlT~ DIST. BOX: GAL ~ <: ,-/Lp_ j L/ 0--- Jt../ COPY 1 - OFFICE COPY 2 - JOURNAL COPY 3 - AUDIT Form # C55-12: METES & BOUNDS 0 YES ATTACHED 0 NO or New System Req. D # BEDROOMS VALUATION >>- , FACILITY PERMIT _____ YES 0 NO ~ DATE ~-/-7 '{ DATE cd- -/ -7"( ~cJ ~#1.J