HomeMy WebLinkAboutPermit Miscellaneous 1981-9-2
4S-)-
[ ronmental Management
ACTIVIl Y INFORMATION SHEET
idne councy
COMPLETE THLS SECTION
~ I '
INCOMPLETE FORMS WILL BE REJECTED'
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CD
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S11\1C ZIP CODE
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pQ.oprPTY o\-INI:.Q./CONTRACT PURC,,!,SER
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BUSINfSS lLLlc.PIl2;:: u 5;::Q. HOrlE 'ICLrPIIONlc. '1UdBER
G 'IJ"\IL ItlFOR.1ATION TO ~PPLICANT/P.EPRI:SI'NTATIVI:
BUSINESS TCLEPHONE NU. BI:.R
HO.E TELEPHO'P:
;lI lBER
D PROPERTY OI'TNI:R/CONTRt"\CT PURCrlASI:R
Q) TA'{ TlAP/PROPI:RTl. DESCRIPTION NUMBI:R (from tax maps In Department of Assessment & Taxatlon or from tax statcmtnt)
TClX Map Number
/7 - [$ - ,.;l(-? .gY'
Tax Lot(s)
4~t?lCJ
o Out of TL jl
Tax map nu~er of adJOInIng property In same ownershIp
D None
By partItIon f
Dun} nown
Ta} Hap NU''''her
Tax Lot(s)
Q SUBDIVISIO'l (l: a_::ohcabie)
BLOCK
LOT
(l (H1\ \lLVlCf ch)
V Q K\ (,f\SL Q
.Qwc Om ~o
l\ Q ~0, lQr)t ~,~ ~ 'r\rr-V\-
j ~
@ "EQUI:ST (bnefly d~scnbe lnforUJi>.l:lOn needed)
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COI~LETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS, OR PROPOSALS
SEE *NOTE BELOW.
**FOR STAFF USE ONLY**
acres
~3 ~
D~T;--- "?f~ - 2 ~
~
_/7'l,'dJ') t:'
__TH1E_INITIl\TI:D IV 7--'-/.
c~
CHECKED BY
CD TOTI\L CONTIGUOUS PROPI:P~N fl\MI:
Q) PPOPG~TY rDDREs~~f \
,
OI'lNI:RSHIP
NmmER
o PREseNT use 0, P~OPERTY
Gclrage
Shop
Barn
ATT~CHED E'HIBITS
o plot PIClns (2)
D Constr plans (2)
D SIte Plan
"
G) ,lU mI:R or S'T'"')LC TL PI:S ON PROPI:RTY
Standard home
~1obIle home
tlodulilr home
RV In use as reSIdence
Storage
Other (~t''-C...f
D CoPy of Tax ~1Clp
D Other
G ACCLSS 10 pDOr1 ~rl
PublJC POild rIamQ
SCRLI:NING VERIrICATION
Prlvale Road Name
'oad Ec1~0mcnt
\-Jldlh
# of
U<...,C1S
By
D.\te
(f) OTl'I:R '=1\',:'" ,["1''' OVER PROPI:HTY
TIme In
Out
o \ \'11 \, [II', [ I, I L
01 TRI: DISTRICT
o Accent D ReJect
Routed to
U ' \ 1', ' 1 ',l, I" 1 \ I TS 0:\ prOpl RIl.
*NOTF
o
7 J 1
(OVEh)
J\TT;\CP 1\ coPy 01- Tt\ '< \~)
StJO." L,IS~I"JG STRloCTU":S
At\lD Tr\^ J.J'I; lq iOLR 01-'-1-
F l--Sf IP OaT\I TAv l.t~....
--I ~-SELF Hl:.Lr Ar<l A
COHPLETE THIS Sr:CTION FOR Ll
USE OR CONSTRUCTION APPLICATI
o PRoposeD use Of' PPOPCPTY IN Dr fAIL
o BUILDING HeQUESTS
Contractor's ~
({or moblle home setup also)
Directions to Site
Check the type of permit requested.
o Dwelling
o NeIV 0 ReplLlcement 0 Addi tional,
o i\ddition 0 Alteration:
o ~lodular Home 0 ~\obile Home - Hodel Year
o RV 0 S1...andard Construction.
o Plan Check Only
o COl1l.!nercial
Use
Floor Area
o Agricultural
Use
o Others
US('
rloor Area
o ChLlnge of Use - How?
@ St\"I fl,T JO,I RrQuesTS
o Slte ('VJlULlLion [or SOS feaSibility
D'le\' svstC'11 1,lstLlllation
o rlcnZllr/rlctllccemcnt
o 1\ltCl ,Lion/relocation
o lIoo} Lo c'isting
1-01)J 1 J01P,L INl 0R.'\\'1 ION
**FOR STAFF USE ONLy*r
ZONL/LA\~SF
By ......~ It.-/'"
Dat~~ O~ ~b~
Time In \0 ~out /\ \ _ 0
/
o Acce[)t 0 ReJect
o Planning l\pnlication
o Construction Pernit Aop
o Information Only
Zoning
Comp Plan DeSignation
Cormnents
(\ (\'l\ - I!
" \C.Cl\'M^'W ( ~c{
V ^ A-~v
- ~.
-=-c
SANITATION.
By.
Date'
'rime In
Out
o Accept 0 Re] ect
o Constr Permit Issue
-~O s-;:te Fvaluation Issue
PCRJ-UT ISSU['D (SA\\C D", O-..LY)
PCinllt #
By
Date'
I'
rime In
out
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