HomeMy WebLinkAboutPermit Building 1973-1-22
LANE COUNT.UILDING PERMIT OR MOBILE HO.USE APPLICATION
PERMIT TYPE - BUILDIN~ MOBILE HOME 0 PERMIT :#= 6;z -/.3
PROPERTY OWNER /J) ~ }#)1l}!jG ADDR~ /I PHONE
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CONTRACTOR / I MAILING jDolfESS' '- / /,/ PHONE
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CATION -INC~E r:fST OFFICE 0' ,L?
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PROPER lEG DESCRIPTION
lOT BLOCK - SUBDIV,
TWP RANGE
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( APPLICANT
METES & BOUNDS DYES
ATTACHED D NO
SEC,
TAX LOT #
,/ '2 t'J0
CODE CENSUS TRACT
/9-c:J/ ) (j-[f'{)C) .
DES6'BE Ea;4:~ PR~N~ ~
LEGAL ACcl:SS TO PROPERTY -/9' J'AME OR # / -'
PROPERTY SIZE-WIDTH DEPTH AREA
NAME
AND
MAILING
ADDRESS
FOR MOBILE HOME PERMIT ONLY
Number of Bedrooms
STRUCTURES TO BE BUILT THIS PERMIT
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2
d-Yt-A.
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Connect to Existing Sewage System 0
TYPE CONSTRUCTION SQ. FT.
or New System Req. 0
# BEDROOMS VALUATION
SEWAGE DISPOSAL
PUBLIC D SEPTIC TANK D OTHER D
BLDG. . /O.O/J FEES WATER SUPPLY
WASTE 015. PUBLIC D OTHER
PLUMBING PLUMBING FEES
PLAN REVIEW _ FIXTURES
PARK TRlR. CASH ~ER
CHECK CONNECTION FEE
//} , 0/) PUBliC WATER
TOTAl CONNECTION FEE
PLUMBING INSTAllED BY
~
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAL.
OWNER D OTHER D NAME
PlANS FURNISHED
YES ~O D
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/ \ FEE~R-~ED BY
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PERMIT #
,6-Z?JJ
COUNTY BUILDING & SANITATION SPECIFICATIONS
DRAIN FIELD REQUIRED
FACIliTY PERMIT
YESD NOD
DATE
/-;//
. DATE
lIN. FT.
TRENCH WIDTH FT.
OR SQUARE FEET
lONE
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FRONT t:> 0 SIDE INT, / ~- SIDE EXT. - REAR 2-0 _
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Directions to Find Property'
TYPE OF STRUCTURE 5 U OC0
BlDG. SETBACKS - FT. FROM CTR. OF ROAD RIGHT OF WAY
"
v/
REAR YARD
PUBliC UTll. EASEMENT
USE ClASSIFICATION
COpy 1 - OFFICE
COPY 2 - JOURNAl
COpy 3 - AUDIT
Form # CSS.12