HomeMy WebLinkAboutPermit Building 1974-9-24
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INFORMATION SHEET
( 4'U1ldlng Permit
Acreage or Lot Slze_
Partltlonl ng #
V4
A c... Z. L
) Site Feasibility Study for Septic Tank
( ) Would like to meet on site Call_
Test hol:;, ~111i?1 ready l/
Subdlvlslon~~ ~~
Number of sites
(owner, etc )
) Completed
( ) Pending
APPLICANT'S NAME AND ADDRESS ~A..7ZW "F-. "'5ur'f"'-;:;1?
,
OWNER'S NAME AND ADDRESS, If different from applicant's
CONTRACTOR'S NAME AND ADDRESS ~ A M 1'L Al ~ A l>>o"U 'IF
/Iail permit or resu Its of site feasibility study to ) Applicant ( ) Owner ( ) Contractor
( ) Prefer to pick up Call (owner, etc ) when ready
Lot
C/
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Block - .
/4 ~6 ~ Afl"'PVl-u:...-va. p:::,~/N.t"AJ...I?J;J:J::) Phone7f7-25/~'?'_..
Phone
Phone
STRUCTURES NOWON THE PROPERTY r/JP1..,-m I L- A4 B 6'l"'Lj;:I ~ A'7i:: -7(') l2..,
PROPOSED USE (this permit) ~,L ~ J?T-~1--, /JL.La, (~p~ ./J~A~ a.f ~ )
I c::7 . d 1/ ;r- t7 ... J
WATER SUPPLY_ ~.A~~ (existing or proposed well, etc
(/ __. +- J
SEWAGE DISPOSAl ~ ,~
I C/ ~
PLUMBING BY
If publiC, name of system)
(existing or proposed septic tank, etc) S I #
Address
) PROPERTY IS WITHIN ONE MILE OF CITY (
******************************************* OFFICE USE ONLY BELOW THIS LINE *******************************************
( ) New Address Necessary
ZONF
) Facility Permit Necessary
SETBACKS Front Side Facing Street
(FROM CENTERLINE OF ROAD)
) SpeCial Permit Area
Minimum Elevation
Interior Side Yard Rear
(FROM PROPERTY LINES)
To Planning/Building Inspector/Sanitarian/Surveyor
ThiS applicant appears to have a problem With
Your assistance will be appreciated
By
Permit Processing Section
Response
C55 12
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th A ven ue
687-4394
DIVISion