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HomeMy WebLinkAboutPermit Miscellaneous 1981-9-2 4S-)- [ ronmental Management ACTIVIl Y INFORMATION SHEET idne councy COMPLETE THLS SECTION ~ I ' INCOMPLETE FORMS WILL BE REJECTED' " G~ex-,/L- .FrDfYl m .(L ., CD ~nPr r':H T/RlPhl SLNTl\fIVF q~~ o e\~~~~rl~Q ~\ ~\r\ O~ Ql'-{l}, S11\1C ZIP CODE t2lP La :\1 ~ "\ 2.Lo ~ Co q 1 "L. W t LL l/~:r"",, (fa s EfJM P V2.lN t::= pQ.oprPTY o\-INI:.Q./CONTRACT PURC,,!,SER q ~~~ (' :~X;>~!:'sl () '\ e <(\ f- ~Y1J ~T\TL q1I~CJEI "LLtD bC(l~ 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) -'~ 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 J