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Permit Plumbing 1976-3-15
):S~ ....3, . .. ~.... . NOTE:!:~O:~:~~ :~~~~~~D ~TIL qjiUmrATI' :~ ~ ~ '~. . ... . ... . .~E~T?i\.~ -1'\ ~ BEEN, APPROVED .-..... . . JAS i'S .APPLICATION FOR: ." \.;~ ~.., 't" 4 . . CPNSTRUCTiON! .x.:'.1 '." ,;'MOBILE irOME .1 I.. . PLAN .REVIEW' , ,I .. CHANGE OF OCGUPANCY I . I. 'OWNd f:L....lh:...Ji4.:"... i7cJff!i~..,:-;,S~,.'.d,d)tduJ ... 7'/~'~~/(, . .'...... /)J!N.;me .. .':'. ",,:""., Ad ress .... CJ.ty~, ,Zl.p . ~ne ' I CONTRAC~OJ(~7),"I>>~: .~)' -d:~ ':: " '. /' '. .' ','" ,(. ' Name' ,Address 'Cl.ty Zl.p P~lOne "o.s: ~E(;','.J("J'(~ " '. ". . ,,' . "'}1:" . , Twp.~" Range,. ~ Section \r'\" Tax Lot Code:- :t~.~.A;:.~.:r:::z:~~.:.!;~~2I~~o~ BI:eki2" ;'o'e'~y~;.., Exi'sting Structu~es 'on ii~opert;:" /7~"." 0",", , .p,o,e"y to,",;op - Md'e;'IDi~e'~i;~' .I/J~? L~ .J1%;L, .+~lu/ ~,,/. , ",-7 ' , .,.; r. /.. ~ fur Offi~USe,~ly~~~~~~~~~~~~~~~~~~~~~~~~~~~ "___~) . ' " ]2' ~.' H . : ~q.. L" . IIBe,droorns Valuation c:::.<:c::> , ';;\ Q>~~ " r~'- '~~C1.~l? ~ "'h~' , ~ ':'": '. (.= iC,,\~\.~<b, . ?-c-~')I::J\ tJ., ~ , C ~r~ '- c.~ _ '-.) :::5 ~ .)(-::J ~ _ "-/~ ~_\o cl @, -S>~ . ," ~ : y.... ~._ , ' .., , ~/~' ,',\ ,~ ,"~1?\D~~V'~'~V'~':~:~-.:P\'~~~ ~rL-.h:L~ SEWAGE DISPO. . " "~~."" .' " ..(..,.. . ..: .. _,_.~ . Site In'spectl II . ~" .'\. _~~:_/ Ex~n~~ ~ew-, e D.1.~posi~Sys;feIn71"'"""...,...(.:.'~r-~yst~!TI ReqU~red I , '. ..' WATER SUPPLY: " --:-__,_,~. ,'<,' ,.:, Pubhc. I ,1,1:' . , Wel; ,. ~Pfi~g t :\\..~'>(r::ni~~{N;~f~=Oi~y 0' Publi, Sy"'~ FEES, ":~:::Ned by,Own" !. :0'",,1.... I Name.'-'a-.42F,j .,~~p-f_.~ :~::~ing;"I~~':. , ,~;fJ. ,(/ i ~ ,~. '. ) ---kll of' ~iittu~~S . ,. ~,~wage' ~ " 'Water ~ 3 % Surcharge .'" COnIlect'ion': ConneCtion'.. '.', ',. ./: PUNS FU'~ , -' fACILITY PERM~IT " . "/",, ./ Mobile Home' ,~'<.' ":' ,,, f 'C~S~ I, 1./1 Y~~ ' T -=-1 '~O' 'I V I YES _ I, NO' ' tOTAL~Q)\~.e.:s',L{~l~I~* '. 'Si~na'tur'e of, Ab~a~A;P"(J4' JIM" . \'e.):~ ~a.S~\S;., " ' '~r"';-o..",""", ti. Fee Receiv~d 'By..:~-{~....p,.~e:, q\~\(}~, ~l'-lh np,' . ~L:) , tlB~~~:d~~i#Jil?t;;~;~?i~~~ Width Depth " Waste Disp. Plan Review .. Type of Construction "-' j '-~/#. , ,~ " ,Group Il:f<I Fire Zone :'" .~: Use Classifita~ion;' '". .j.' . BldgSetbacks - fro:n. cente.r,~fRoad'pght on;la~,rdt;;,' . Front, ( il' Side .Int. . t;.. 'Side Exterior l:t7 \, . PlANNING: II APJ...:, b); "~Jl~ . \ ,,:<-r ,. -~ '1'- 1f '('55-12 ,..( ,DATE: ' t)Pf/ i' "R~ar ,\ *1 /jPUl:Ezone 1<. ,k . 4lr~~ . 51::)'7' ......~~~t!i3'l~:J'1 LANE ,COUNTY ~PAR1M'E~T {I ENVIRONMENTAL ~AG~:;T' . /. ", \ JI