HomeMy WebLinkAboutPermit Building 1977-4-28 (2)
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INFORMATION SHEET
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t><rBuilding Permit ( ) Site Feasibility Study for Septic Tank. Number of sites
( ) Would like to meet on site. Call , (owner, etc.l
Acreage or Lot Si7e Test holes will be ready
Partitioning # ( ) Completed Subdivision, Lot Bloc~
( I Pending,
APPLICANT'S NAME AND ADDRESS { )" <:<7'0- SrJ._....... :)Cl.!S..'f,.......HJ,^, ~..." {;:'A~9-^" a... q~YrJ I Phone~~ ~-L. '1,,-<(
OWNER'S NAME AND ADDRESS if different from a!1plifant's..-v..'7"^a~ r-Ij;;'y, "1"" ,,"r-;a.... ." ~.~ Rl(, C'~~,."aJPhone -'7IJl -" '''..IS''
CONTRACTOR'S NAME AND ADDRESS ..I.111.~o... S,cJ.....r c;;.:"'f-r"c'(,;'",, .1l. A1 R~ ,<:0"../" {:::,. J --., lr)v~ - q')-y~'r ' Phone ~''1'\ -L C},c-f.J
~ Aail permit or results of site feasibility study to ( ) Applicant ( ) Owner ( I Contractor.
, --r ) Prefer to pick up. Call_G:Zll::iNHt..v- (owner, etc.l when ready.
PROPOSED USE (this permit)
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STRUCTURES NOW ON THE PROPERTY
WATER SUPPLY
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-~isting or proposed well, etc. If public, name of systeml
SEWAGE DISPOSAL
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(existing or proposed septic tank, etc.) s.1. 4' -
PLUMBING BY
Address
:t><:rPROPERTY IS WITHIN ONE MILE OF CITY t Y.......
******************************************* OFFICE USE ONLY BELOW THIS LINE *******************************************
. ( ) New Address Necessary ( ) Facility Permit Necessary
~ ZONF. SETBACKS: Front _ Side Facing Street
(FROM CENTERLINE OF ROAOI
) Special Permit Area.
Minimum Elevation'
Interior Side Yard Rear
lFROM PROPERTY LINES)
To: PlanninglBuilding InspectorlSanitarian/Surveyor.
This applicant appears to have a problem with
Your assistance will be appreciated.
By
Permit Processing Section
Responso'
C55-'2
, By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
687-4394
r'livision
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