HomeMy WebLinkAboutPermit Signage 1988-9-9
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,,_ Environmental _ Manag '.en't
ACTIVITY INFORMATIUN
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lane c~unty
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SHEET
:O~~~~ZION',~:::::E
· - ~ ' -, PERSON ~ffiKING REQUEST
REJECTED~
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PROPERTY OWNER
HAILING AIDDRESS
I1AILING ADDRESS
CITY
STATE '
ZIP CODE
CITY
STATE
ZIP CODE
BUSINESS TELEPHONE NUHBER
HOl1E TELEPHONE NUHBER
BUSINESS TELEPHONE NUMBER
HOME TELEPHONE NUHBER
<V TAX MAP/PROPERTY DESCRIP'l',ION NUMBE~(frOm tax maps in Department of Assessment & Taxation or from tax statement):
Map & Parcel Number: /1 I )\.:s Z't 4- Tax Lot (s) : Z ? () 1
~shiP Range Section '
o Out of TL # By Partition #
Tax Map & Parcel Number of Adjoining Property in Same Ownership:
Tax Lot(s):
To\Vn,~hip Rang~sectlon
o None 0 Unknown
(j) SU'lDIVISION 'i< oppliOob10)' 01< ~_. . c:~ BLOCK,
@ REQUEST (briefly describe information needed): ---K-. ~ ~ ~!~ ~_ '~:-J
j .m 1" - .
LOT:
~
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS" OR PROPOSALS. SEE *NOTE BELOW.
**FOR STAFF USE ONLY**
24- ~
CD TOTAL CONTIGUOUS PROPERTY IN SAME mVNERSHI P: acres
NUMBER:
G) PRESENT USE OF PROPERTY:
/\,,, J tJASbVl (A
n !C^- iu..~
V
Garage
Shop
Barn
DATE: C1~4 ~
I I ~
TIME INITIATED: ~c:>~
CHECKED BY: ~ '
ATTACHED EXHIBIT~
o Plqt P'lans (2)
o Constr. Plans (2)
o Site Plan
o Copy of Tax Map
Dother
<V PROPERT;c ADDRESS: 'Cf/7 0
.. (
@ NUMBER OF STRUCTURES ON PROPERTY: Standard home
Mobile home
Modular home
RV in use as residence
Storage
Other (specify)
@ ACCESS TO PROPERTY: Public Road Name
SCREENING VERIFICATION:
Private Road Name
By:
Road Easement
width
# of
Users
Date:
@ OTHER EASEMENTS OVER PROPERTY:
Time In:
Out:
(]) WATER DISTRICT:'
@ FIRE DISTRICT:
o Accept 0 Reject
,@ PENDING PERMITS ON PROPERTY:
Routed to:
*NOTE: ATTACH A COPY OF
. TAX I1AP; SHOW EXISTING ,
STRUCTURES AND TAX LOTS
_ /' / IN YOUR OI'INERSHIP. 013-
l 'M' TAIN TAX H]\P IN SELF'
'-- ~jC>_p, HELP AREA OF A & T_
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9/81 REV ~ ~VER) s'C"'\.A-
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CONSTRUCTION APPLICATIONS.
1
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COMPLETE THIS' SECTION FOR LAND USE r
49 PROPOSED USE OF PROPERTY IN DETAIL:'
"
~ BUILDING REQUESTS:
Ii
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Direction~ to Site:
(for mobile home setup also),
Contractor's #
Check the type of permit requested:
D Dwelling: D New
D Addi tion
D Replacement
o Alteration; ,
o Modular Horne D Mobile Horne - Model
DRV
D Standard Construction;
[] plan Check Only
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D Corrunerci~l: Use,
I
DAgric;ultural: Use
,Floor 'Area
D Others:' Use
Floor Area
D chcinge of use, -How?
~ NUMBER OF BEDROOMS'
Q) SANITATI~N REQUESTS:
[]Site evaluation for SDS feasibility
NUMBER OF STORIES
[]New system installatio~"
[] Repair/:r;:eplacement
[] Al teration/relocation
[] HO,ok to ~xisting
ADDITIONAL INFORMATION:
o
o Additional;
'Year
~',
'"
" *FORSTA~F
.~-
ZONE/LAND USE:
USE ONLY**
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BY:\).Al ~
Dat,e:
Ti~e In: O~t:
[] Accept 0 Reject
[] Planning Application
';[] Construction Permit App'.
o Information Only
Zoning: ,
Compo Plan Designa.tion:__
SANITATION:
By:
Date:
Time In:
out:
o Acc~pt
o Reject
Dconstr. pe'rmit Issue
o Site Evaluation Issue
PERl-lIT ISSUED (SAME DAY ONLY):
Permit #
By:
Date:
Time In:
Out:
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