HomeMy WebLinkAboutPermit Miscellaneous 1977-01-013\\t r\t
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( ) Building Permit
Acreage or Lot Size
Partitioning#-.- ( ) Completed( ) Pendi
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS, if di
CONTRACTOR'S NAME AND ADDRE
rilpermit or results of site feasibility stu
) Prefer to pick up. Call
STRUCTURES NOW ON THE PROPERT z <tuz
PROPOSED USE (this permit)
o Job Location
INFORMATION SHEET
( ) Site Feasibility Study for Septic Tank
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Test holes will be ready
(,Am*B (2,
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rcant ( )Owner (X)Contractor
(owner, etc. ) when ready
CA.A Crjt't-l-l S'r.t€-A€€i P,rat.\o{IT
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Subdivision Lot _ Bto
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existing or proposed well, etc. lf public, name of systeml
(existing or proposed septic tank, etc.) S.l
WATER SUPPLY
SEWAGE DISPOSA
PLUMBING BY Address
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Fc>rn() PROPERTY IS WITHIN ONE MILE OF CITY ( )o******+********+*************+********r+**** OFFICE USE ONLy BE LOW THIS L ****+t******I **t+********* ************+*+*
() New Address Necessary
ONE=-_-
( ) Facility Permit Necessary
Side Facing Street lnterior Side Yard Rear
-
(FROM CENTERLINE OF ROAD)(FROM PROPERTY LINES)
SETBACKS: Front
To: Planning/Building lnspector/Sanitarian/Surveyor,
This applicant appears to have a problem with
Your assistance lyill be appreciated.
By Permit Processing Sect ion
Response
By
DEPARTMENT OF ENV I RONMENTAL MANAG EIVIENT
Permit Processing Section
125 East Bth Avenue
687-4394
D ivision
c55-12
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( ) Special Permit Area. Minimum Elevation:
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