HomeMy WebLinkAboutPermit Building 1974-9-20
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DEPAR1MENT OF ENVIRON1ENI'AL Mobile Home
APPLICATION FOR BUILDIN:; PERMIT OR MOBI' HCME USE
PLEASE PRINI' NOTE: No pennit ~ll be issued tn1til~. is application tas been approved,
PROPERlY LOCATION \-....Cl.rI\r ~~.51- '---L)es ~ ~,~-e.._ ~P('. A 1Y\"v-. c\
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'M' \'\ RAN;E c)~ SEe, \.~ TAX LOT IIQC'l(LCXIlE\..\-o4CENSUS TR!CI'
LOT NO. j3I.JJCK _ SUBDIVISION
ACCESS TO PRul't.K1~Pr\.~\';-o'\, ~ <:::\,.,--:\,€,,&~PER1Y ~IZE DEPlli - OR ACRE!GE
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DESCRIBE EXISTIN; STRIJCIURES ON 1HE PRur=.J.-{
APPLICANr.L\ { ('.".1'\. I, MAll.IN3"" \ \, c:::. ""\ I ':)::::.O'-l~<2 II e....
NAME "-\''--~ "\. '\ '\ \a., '>.<.. ~a "'" Auu=S ~ ....., \.D "C) 0 )< r-J 10. ~t1CNE
w~~, a~,~. CA~"cs.a=~~::?~Q..~~~" S-\: PHONE~k\I\--~~
l3ELClV FOR OFFICE USE ONLY*****:....,..:.......:. :.:.:.:...:. ,.:.:.:. ;.~;.-:'..;.;. ;.~,...;.;.;,;.....;..,;. ;...;.;, :... ;...:.;.;..~;. ;.;._. .\i,AAA AA
~uctures to be 1;>tri.;LtjMobi]& Home sq. ft~ 1Fblfdrooms I. valuation CO
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::iewage J)1.spcillal: '- v
Site Inspection II Zxisting sewage disposal systan 0 or new systan required 0
Water ::i'::!EPly: I(
Public U District Nane Well ~ Spring 0 Other ~ -e'--\
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.....,
Bldg.
Waste Dis.
Plumbing
Plan Review
Trailer
1% surcharge
1oL{.00
%-D~
~ (~ ..., L 0ilieck
Fees
Plumbing Installed by O;vner Other Natre :
Plumbing Fees Sewer cormection Water ~ection
I-.\, II of fixtures inspection fee :iru;pedion fee
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E'ifcility Pennit
0- [] ,
"s ~ datet.4;hb
Plans furnishe
Yes 0 No
Signature of Appt.,.cant
Fee received by .......
Drainfield required
Lineal Feet
~
,~,oo
TOrAL
~
Min. Septic tank capacity
with dist. box: Gallons
Trench Depth
or Sq, Ft.
.J' '
Type ot Structure ~- {,} Occupancy! .hre Zone
Blgd, setbacks-tt. trom center ot road right of way
Front Side Int, Side Exterior
Use Classitication
Planning
date ~ton q/;q/1Jr
~.. .
Rear Zone
J1j- Building /J' date
F II .).,
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C55-12