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HomeMy WebLinkAboutPermit Building 1976-6-22 .' \ , \ NOTE: NO PERMIT WILL BE ISSUED UNTIL THIS APPLICATION HAS , .\ \ APPLICATION FOR: -. I I MoinLE 'HOME ' PLAN REVIEW I ')( ~..l.Ji"'t> OWNER---Eh~-l-e~ari1e..rk'~~)~\L 'A~S~ -xJsr;eh ~{i~~cfe/l~ ?~e ??~~ne ?(j'l69:JJ f' (F"11.<:"':~'l tflU'1y , , A-lLi. 6}l- ~ . -=, CONTRACTOR N~h<( l~f"J r., Ik,Y.;;'",. <l1k .< ~ . o.,.":.c., Ja'l;~~ ;;';'ifB1J9' ~~AZiP'l1q;Z Twp.~') S6 Range 3U'-~M. Section,&tLb ~J~.':3\[Tax Lot ~1!J Census Tract Subdivisior0!tJ1I f C/~f1r trl<:l.JI"-hd1., Lot BlOCk;' Property Acreage j J/~ Width Jf? Depth ~'j? E::::::g ~,:::::: ~~;:o:::, )h~:q ~[~~ <no. _L% <'i u", Property Location - Address/Directions: ,t,6s' ~e" Stl C;~ ' . U I ' t<tJ~d. s/,t. 'tk.it ..F~~J"e!e.i? ~~ 'lfedcl' . +U~Jt J../(J}1( e, OJ.( . Je-f-f . / Below for Offtce Use ~IY~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ U~~) /V. /7//& /-q. Ft. . . 1!~edroOms Valuation ~/U ~~ ~ I Ml7.4?:J/'L./:l!d, . . ~ /, /)/)?) P'" C/ I ~arA,.-&4//~, .'.-' l' f/- - - PERMIT #./--5//56=.7~ BEEN APPROVED , CONSTRUCTION I VI CHJU~GE OF OCCUPANCY , SC~ e>f'f C 'Pn :t ('11 me I ~o ~ es-r/- t'7~ ROck !loecf. Bldg. Plumbing 3 % Surcharge Waste Disp. . Plan Review Mobile Home //,,00 Ot~~ . \ PLUMBING: I Installed y' oWn r I PLUMBING F S: isposal System or, New System Required , SEWAGE DISPOSAL: Site Inspection 1/ WATER SUPPLY: Well ,Spring I I Name of Community or Public System FEES: I ' 'Other I I Name ,~~ C~ri~ Water Connection , " .,;f::1 )f Fixtures TOTAL / /,;;j.:2 I. CASH / 'J j/ I CHECK ~ PLANS FURNISHED FACILITY PERMIT / ' ( LKJ YES . I I, NO .J) I ,] I YES I V NO Signature of Applin: f4?L4.JIMY. P~a./U~ . Fee Received By: }~,(/?a ./ Date?d-~ , Min. Septic Tank Capacity Drainfield Required - Lineal.' Feet, Maximum Depth Type of Construction ./ II // \.. '!V Group / Fire Zone Use Classification Bldg setba,~, rom cente,r 0, f Road ~ht ::.fway:., Front ,'Side.lnt...,..,.. - Side Exterior , , - ,..- --..., Rear Zone P~yl.g,~ '.( ~tufMp-?~ DATE: SANITATION: ~~6 --;<2~?6 ENVIRONMENTAL MAN.tm:ENT I w- DATE: C5S'- 12 LANE COUNTY DEPARTMENT OF