HomeMy WebLinkAboutPermit Building 1976-6-14
, CI OWNER ISo- b.... /1-<.. c;-<J"""-9- H., :lL/LlQ H..-.. 'd....
Name 0 Address 8r.
CONTRACTOR ~ol..!'l Cd ~~'..J\, 1,,[.2 Wo..h~ S +.
Name -.J Address ;:
O,S, REG, II 0(') D n I ~o 9 (I
1- Twp,-'--.7 '5 Range..:? W Section 1.. " Tax Lot :La 0
S~divi~ion Lot taCk
ACCESS TO PROPERTY (Road Name) H-Q~ A~- 13,,,-.d~J
Existing Structures on Property: 1.. /"IU $~_ ~ '
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/:' /l ,f /~ ' ,d.. ~~ Sq, Ft, /J ,,(fBedrooms Valuation
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. (,-33.77
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City () . Zip Phone
SI'~'!1~ r::-<'/J q71/77 (1']<l7-731tf.r)
CUy Zip~, Phone '/ ,
~
Code
I q -0 '-I
Census Tract
Property Acreage
!J-,,--
, ,
Width If"ODepth i I d
Property Location - Address/Direc~ions:
j.J "-'t ,./-<~
A...."1'(L
~d
SEWAGE DISPOSAL,
Site Inspection #
)
EXistng Sewage Disposal System 0
Public ~
Community ~ Name of Community or Public System
I
or New System Required c====J
WATER SDPPLY:
Well Spring ~
FEES,
Bldg,
Plumbing
3 % Surcharge
Waste Disp.
Plan Review
t:,. tft:J
~
Other
Water
Connection
,/.9
Fixtures
PLANS FURNISHED
FACILITY PERMIT
Mobile- Home
I2:f YES CI NO c====J YES i:Zr NO
Signature of A'PPlicant:c9~ @~ .--
Fee Received By: .-S;.-~--"" Date:~.4:-7 -7'
TOTAL _~, / ~
Min. Septic Tank Capacity
ield Required - Lineal Feet
Maximum Depth
Type of Construction
...,/
~.N
Group
/
(
Fire Zone
Use Classification
Bldg,..:etb~ -f from Center of
Front ~GI Side Int.
Road Right of Way:
/S' u.u" uA""uu.
Rear ~'
Zone Ab/
P~~~:
Ch(;I:TZ -7-21..
DATE:
~ SANITATION: ' ~TE1!w" I ~G' / //
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COUNTY EP~NT OF ENVIRONME 1\L MANAGEI-IE
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LANE