HomeMy WebLinkAboutMiscellaneous Miscellaneous 1981-9-8
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COMPffTE THIS
CD WA2-<J
SECTION~~TE
PERSON MM(.INQ' REQU~T
FORMS WILL BE REJECTED:
- ._.~
bne county
.
.af.nvironmental Managemen..
ACTI_l y INFORMATION~HEET
PROPERTY OWNER
MAILING AIDDTillSS
MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
BUSINESS TELEPHONE NUMBER
nOME TELEPHONE NUMBER
BUSINESS TELEPHONE NUMBER
HONE TELEPHONE NUMBER
@ TAX MAP/PROPERTY DESCRIP'l'ION NUMBER (from tnx maps in Dcpartm~nt of Assessment & Taxat10n
Ilap & Parcel Number: r, 3 ~-l./'-I Tax Lot(s): '-lio!
Township Range Section
or from tax statement):
o Out of TL t
By Partition #
Tax Map & Parcel Number of Adjoining Property in Same Ownership:
Tax Lot(s):
Township Range
o None
Section
o Unknown
Q) SUBDIVISION (if applicable):
JLO J/J
L1:Pr~~l. -
N? (t?/~7 g'
--7~"--'
-....BLOCK: LOT:
(~ t~eA-
\ /'Y) /fp)
./
@ REQUEST (briefly describe information needed):
COMPLETE THIS SECTION FOR LAND USE
CONSTRUCTION APPLICATIONS, OR PRop6sALS. SEE "NOTE aELOW.
<D TOTAl, CONTIGUOUS PROPERTY IN SAME OWNERSHIP: acres
NUlmER:
STAFF USE
~/T
q~.1
ONLY".
..FOR
Q) PRESENT USE OF PROPERTY:
>-3
fJl
TIME INITIATED: 3X ~
CHECKED BY: ~
ATTACHED EXHIBIT~
Gl> PROPERTY ADDRESS:
DATE:
Garage_
Other (specify)
Shop_
Barn
o Plot Plans (2)
[] Constr. Plans (2)
o Si te Plan
o Copy of Tax Map
Dother
@ NUMBER OF STRUCTURES ON PROPERTY: Standard home
Mobile home
Modular home
RV in use as residence_____
Storage_____
@ ACCESS TO PROPERTY: Public Road Name
SCREENING VERIFIChTION:
Private Road Na~c
By:
Road Easement
Width
i of
Users
Date:
@ OTHER EASEi-1EN'l'S OVER PROPERTY:
Time In:
Out:
(i) NATER DISTRICT:
o hccept 0 Reject
@ FIRE DISTRICT:
9/81 REV
(OVER)
-1..Ss '2. N ()VtA...
Routed to:
-NOTE: ATTACH A COPY OF
TAX MAP; SHOW EXISTING
STRUCTURES AND TAX LOTS
IN YOUR mmERSlllr. OB-
TAIN TAX HAP IN SELF
HCLP AREA OF A & T.
@ PENDING PE~~ITS ON PROPERTY:
r COMPLETE THIS SECTION FOR LAND USE OR CONSTRUCTION APPLICATIONS.
@ PROPOSED USE OF PROPERTY IN I-IL: . .
Q>> BUILDING REQUESTS:
Contractorls #
(for mobile home setup also)
Directions to Site:
Check the type of permit requested:
o Dwelling: 0 New
o Addition
o Replacement
o Alteration;
D Addi tional;
o Modular Home 0 Mobile Home - Model
o RV D Standard Construction;
o Plan Check Only
Year
,
0, . l'
CommerCl.a :
.\ Floor Area
,
Use
o Agricultural: Use.
'.
o Others: Use
Floor Area
o Change of Use - 'How?
~ NUMBER OF BEDROOMS
NUMBER OF STORIES
~ SANITATION REQUESTS:
[] Site evaluation for 50S feasibility
o New system installation
D Repair/replacement
[JAlteration/relocation
D Hook to existing
,
ADDITIONAL INFORMATION:
-,~""IIIIII
**FOR STAFF USE ONLY**
:::E/\; ~~LC ')
Date:
Time In:
.Jut:
o Accept
o Reject
[J Planning Ap91ication
,0 Construction Permit App.
DI~rmat' Only
. "Z-
Zoolng:
Compo Plan oesignation:__
,,~ oar,
y~0~t--
SANITATION:
By:
Date:
Time In:
Out:
o Reject
o Accept
o Constr. Permit Issue
o Si te Evaluation Issue
PERMIT ISSUED (SAME DAY ONLY):
Permit #
By:
Date:
Time In:
Out: