HomeMy WebLinkAboutPermit Building 1966-04-07I I lsI
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liorth 37th Street,
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bne countyEnvironmental Management
ACTIVI_Y INFORMATION -"- iEET il!'
-
COMPLETE THIS SECTTON. TNCOMPLETE FORMS WILL BE REJECTED:
PROPERTY OWNER,/CONTFACT PURCHASERF T I CANT /i F€ P FE SDNTAT I VE
TllTILING ADDRESS MAILING ADDRESS
CITY STATE ZIP CODE CITY STATE ZIP CODE
BUSINESS TELEPHONE NUMBER HOME TELEPIIONE NUMBER BUSINESS TELEPHONE NUMBER HOME TELEPHONE NUMBER
@ uarl TNFoRMATToN ror Ierer,rcanr/REpREsENTATTvE I enoeentY oWNER/CoNTRACT PURCHASER
@ r*x MAp/pRopERTy DESCRIPTION NUMBER (from tax maps in Department of Assessment & Taxation or from tax statement):
Tax Map Number:Tax Lot (s) :
I out of TL #-- By oartition {l--.
Tax map nurnber of adjoining property in same ownership, f None I Unknown
Tax Map Number:Tax Lot (s)
@ SusorvrsrON (if applicable):BLOCK:
t
LOT:
@ neQUnSt (briefly Cescribe information needetl):
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS ORP SEE *NOTE **FOR STAFF USE ONLY**
NUMBER:74-
g-tq'trl €
H
F:ltrthTIME INITIATED: I I
DATE
CHECKED BY:
ATTACHED EXHIB]TS:
@ torar, coNTrcuous PRoPERTY rN SAME owNERsHrP:acres
@ PROPERTY ADDRESS
@ ennsrut usE oF PRoPERTY:
@ nuuaen oF STRUCTURES oN PRoPERTY: standard home-
Modular home- RV in use as residence-
:Garage ShoP-
Mobile home_
Storage--
Barn_
uLIlcl tSpcelr\ /
@ accnss ro PRoPERTY: Pubric Road Name
Private Road Nane
Road. Easement width
#of
USeTS
@ orgrn EASEMENTS ovER PRoPERTY:
O wnrun DISTRTC'I:
O ri\Is'r'rNG PERI.lrrs oN PRoPERTY
@ rrne DrsrRrCT:
fl nrot Plans (2)
Iconstr. Plans (2)
I site et"n
lcopy of Tax Map
E ott"r--
SCREENING VERIFICATION :
By:
Date:
Time fn:Out:
l--l accept [-l neiect
Routed to:
*NOTE:
ATTACH A COPY OF TAX I'IAP;
SHOWN EXISTING STRUCTURES
AND TAX LqTS IN YOUR OWN-
ERSHIP, OBTAIN TAX MAP
IN SELF HELP AREA.
1 /eL (ovER)
o
@
THIS SECTToN FoR xND USE dR coNsTRuCTIoN APPLICAT=.NS **FOR STAFF USE ONLY**
PROPOSED USE OF PROPERTY IN DETAIL:ZONE/LAND USE
By:
Date 3
@ BLlILDING REQUESTS:
Contractorrs #(for mobile home setup also)
Directions to Site:
Check the type of permi,t reguested:
Iowelring: Illew [Replacement trAdditional;
I aaai.tion I alterationi
fJ Modular Home I uoUir. Home - Model_ year_
fl nv fl standard Construction;
I rf"., Check only
l-l comrnercial: use Floor Area
Time In:_ out:_
fl accept I neject
I nlanning application
I Construction Permit App
fl tnformation only
Zoning. _
Comp. Plan Designation:
Comments:
SANTTATION:
By:
Tlme In:_ Out: .
I accept f] nei."t :
f] constr. Permit rssue
I si-t" Evaluation rssue
PERMIT ISSUED (SA},lE DAY ONLY):
Permit f
By:
Date:
Time In._ Out:
! egricultural: Use . ,
[] otr,..": use Floor 4rea_Date;
f Cf,..,g" of Use - How?
@ sanrrnrroN REeuESrs:
fl site evaluation. for SDS feasibility
I New system installation
f nepair/replacement
fl alteration/re Iocat ion
! uooX to existing
ADDITIONAL INPORIIATION !