HomeMy WebLinkAboutPermit Building 1976-8-10
NOTE:
___ . PERMIT iF/lJJI-~?3--7~
NO PERMIT WWBE ISSUED UNTIL THIS APPLICAT .HAS BEEN APPROVED
APPLICATION FOR:
CONSTRUCTION c::=J
MOBILE HOME ~
PLAN REVIEW c:::J
CHANGE OF OCCUPANCY c:::J
c6 OWNER Ma,..., 'l. '1 I.. . l3 Pa... c.-4 /755 Gu.~.:T,'s t;" Je.., " 971./0} 'f((,s-- 00 If'f
Name Address City Zip Phone
c=J CONTRACTOR
Name Address City Zip Phone
O.S. REG. II
ACCESS TO PROPERTY (Road Name)~ttl1"1e_ ~I'\'" RDcui
Existing Structures on Property: N f"j ne-
/.
Tax Lot _< 7 D 0 Code d'~ 2.. 2- Census Tract
pro~y ACreage,J~ 3 I Width_Depth
3':l3b /7
PropertyLocation-Address!Directions: S,C ""nt-ne..- or:- J}~~h10H ciS' Fe,..,. V fi!,/ and
G;a.11'I e Fa.... I'n R.J L /J ,J '
3' S 3 S- ~ _.p f;~! !<t?~)' .?: ~~ q-J~D I
Below for Office Use OnlvXXXXXXXXXX . xxxxxxxxxxxx~xxxxxxxxxxxx~_
~" ,} L /. / Sq. Ft. /I I/)Iedrooms Valuation
/' /Z.?.//' _ L/'h A4L/ A; " 11.:l .
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.-!kAZ;fAf ~ (~~fJ)"
Tw-p.
/'7
.
Range .3
Section
/<
Subdivision
Lot
Block
FEES:
PLUMBING,
Installed by
SEWAGE DISPOSAL:
Site Inspection u7A'...,<;""7S-
WATER SUPPLY:
Well Spring _ Other
Community ,
stem c::=J or New System Required .~
-- Name of Community or Public System ~
er c:::J,lli Other c:::J Name
PLUMBING FEES,
Fixtur:~, s Sewage
!J Connection A
\ "I
\ I'
"
I'
i
,
,
,
r
~ I
Min. Septic la~kr~acitl 7i"7"J , ;DrainUelj R~ff~4t /(70 ' Maximum Dep~_?.6
.!J'/J.,Hf}eld mho. JcYA~:.;T; " fflO/:u./t> hl)~ Sfu<'.
Bldg.
Plumbing
$/, tJO
__L./ .:l..
.:? .;; Iff2-
Water
Connection
;;2,
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
:'30, ern
o CASH
~ CHECK
~~~RNISHED FACILITY PERMIT
~ YES c::::J NO c:::J YES~NO
Signature of APPIicant;~<?4(;'",C~ 'J!ad,
Fee Received BYS/~ Date, -9-7t::
TOTAL
ll3.ff. I 2-
~ ~c.66.
Type of Construction
Group
Fire Zone
Use Classification
BIdg Setbacks - from Center of Road Right of Way:
F ~ I Sid I /5 ' .. . - .
ront ~ e nt. ....___ _.._____OG4!>
Rear ~.
Zone ~T 't.O
~q-7(_
, ,
C55-12
DATE:
1~:JJ;,<~8jfh ~~
COUN~1MENT OF ENVIRONMENTAL MANAGEMENT
DATE:
-;t- /CJ-7 ~
LANE