HomeMy WebLinkAboutPermit Building 1976-8-10 (2)
NOTE:
NO PERMIT 4BE ISSUED UNTIL THIS APPLICAT.HAS
APPLICATION FOR:
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PERMIT fF
BEEN APPROVED
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MOBILE HOME [=:J PLAN REVIEW [=:J CHANCE OF OCCUPANCY L=:J
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Name ,,' I Address I City (...1'0 Zip
'D, t\ (!/JPkipAJde..JAJG f /) ,80x. ;;l)Q2. Gu.q~ q 74-(;)~
Name Address CHi Zip
Subdivision Lot Block
ACCESS TO PROPERTY (Road Name)_f'..;7 h": ~lIi '.:k~ /2,x"L IT
Existing Structures on Property: ,,(")f'/ ~ \t.)_.r; /' :ZI 1/
Property Location - Address/Directions: 1J0nuz... ,,,:::,Z14.;..Jt.- ~i- ;t;) l)L/J/r~ MAJ1J;
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Below fo r Of f ie e Use On! VXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX;::.PCXXXXXXXXXXXXXXXXXXXXXXJOOC<XXXXXXXXXXXXXXXXXXXXX
/1 / f, /;rZ-' /? q. Ft. OBedrOOmB.6' Valuation
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SEWAGE DISPOSAL: - 1: --
Site ro.spection U Existing Sew e Disposal System ~ or New System Required c=:::J
WATER SUPPLV.......------ Public c=:::J
Well ~ Spring Other . Community c====J Name of Community or Public System
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CONSTRUCTION [=:J
[=:J OWNER ~
c:::=J
CONTRACTOR
O.S. REG. n
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Range 0 3
'lWp,
/1
FEES:
/ Or CT
Bldg.
Plumbing
3 % Surcharge
Waste DiBp.
Plan Review
Mobile Home
, C? ,;)
TOTAL
LLi. oJ c:.;..
,
Min. Septic Tank Capacity
_M,;;-J!t; d h~
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Type of Constructiol'\ _ ~ A./
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Phone
:;;({.3.,r9;;;o
Phone
Section
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,
Tax Lot 91ft:)
Code IJ{)(../-O c/.US Tract
Property Acreage ~n.' Width______Depth
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: ~~~~~:~f Owner /11;1 [=:J Name
i PLUMBING ES:
I
) _0 of Fixtures Sewage
/ Connection
PLANS FURNISHED
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Water
Connection
FACILITY PERMIT
[:=::J YES ~ ~Q
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, Date:J!' -<C\ ~
Signature of Ap
Fee Received B
~ Drainfield Required - Lineal Feet
fJ:~ud,~ln 'k.& O~ ~
4'i / ;JIsErru .
Maximum Depth
f-:!: o:r a~y
Croup /.... ~
~
Use CIassification_ ~J ~
Fire Zone
BIdg Setbac~ -'from Center of Road Right of Way:
Front ~) Side Int. '1<" SJ.'~' ':'__h_ -~ Rear 2/)' Zone----kr
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::;ftIW f3-G-7l DATE: ~ITA,:q~ON: ~~: ,L n... BUILDING: DATE0:
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..) CSS'I! LANE COUN EPARTMENT OF ENVIRONMENTAL MANAGEMENT