HomeMy WebLinkAboutPermit Building 1975-11-19
NOTE: NO PERMIT W~
BE ISSUED UNTIL THIS APPLICAT:
PERMIT 4ft 300; /-7!5
HAS BEEN APPROVED
i.1
~I
CONSTRUCTION I ~ILE ~lOME I
/"
'~/lAIE!f
Name
APPLICATION FOR:
OWNER
,40
PLAN'REVIEW I I
.f\-\- €lI\ %1fJ/.
Address . 'City
C!lANGE OF OCCUPANCY' I"
SQ~d I 97L/77 .
~ Zip Phone
7'1 6 -b ;2 YrCj
Zip Phone
CONTRACTOR
Name
Address
City"
O.S. REG. I'
j. Twp.~ Range o"? Section
Subdivision
;;2 ;:1.1# tf
,~ 'Tax Lot 0 / q 0 0 Code / q - 03 Censup Tract
,
Lot
Block
Property Acreage
Width
. Depth
-I ACCESS TO P~OPERTY (Road Name) ~\ I-PI^- .A:t.t-e-
~ Existing Structures on Property: h(:)l) ~ ";" ' '" //.~'
i PCO~LOO':;;;AY~i:OUO\aV\e~A'\~ ~~~~~{:t-J
0\ (~K' , '-.J / \.j
Below fo r 'Off ice Us ebnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXxxxxXxXXXXXXXXxxxxxxxxxxxxxxxxXX-fiXXXXXXXXxxxxxxxxxxxxxxxxxxxxxx
h \ ~ Cl F~. 02 V X;J. 0- J[;r/:ms llag;:;t; ,--
'" t9<lY/h :/ L/L/f 125W. Vi)
, - :/
/ :~ 7'fC6 I t./n
Existing Sewage D. i,;".1 SYO'''''{ ~ ~N~ Sy"~ .equio<<l I '
" Public ~ '
Other Community 1/ I Name of Community or Public System
/
/
/ I. Other I
~'~C)J? .;
r:.nrfJur \
Clt( -R S So-r-\/
/
SEWAGE DISPOSAL:
Site Inspection #
WATER SUPPLY:
Well
Sprj,ng
Bldg.
Waste Disp.
Plumbing
Plan Review
;;; <:j. ---
PLUMBING: (
Installed bi Owner
PLUMBINGr IS/"
/
I Na~e~/l rl
- --
~-kfLA/
FEES:
Sewage
Connection
Water
Connection
Mobile Home
1% Surcharge
, PLANS FURNISHED ,
FACILITY PERMIT
TOTAL
,?;l./
I
0( b, &fijl
/
1 CASH
~
~ I, INO I '!YES I~
Sig~ature of APPliC~n;5< ~ ?~~
Fee Received By: 'e. t::::>. Da~: / /-' /L/
~ '/
Min. Septic Tank Capacity
~ 'V'Lt.-t h k ~ti ,
Drainfield Required - Lineal Feet
u)\c~ 11) (6{) JA~L,...
Maximum Depth
Type of ,Construction
- /
(.tj 11/
-
Gro~
Fire Zone
Use Classification
Bldg Setbacks - trom Center of Road Right of Way:
.A~ ,/ , I
Front ~./<l).'Si.de Int. ::; , ,::'.,h_Jil".......i.or
/- .
. I
Rear 6
Zone RA
PIA lliING:
GfJ2R_..(j,.h/4--i~
DATE:
SANITATION: . , ,DATE: 1!UIi.DINGXf /Y DATE: ....
In - /G,^f)bA --Y-?l ~~~ /1-/9-?.s
C01l\'<TY DE~ENT OF E7!:R~~NTAL NAGEMENt" , . .'
C55- 12
LANE