HomeMy WebLinkAboutPermit Building 1974-8-29
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IANE COUN'IY "", /
Building
DEPAR'IMENT OF ENVIROI:-MENTAL ~ Mobile Home
APPLICATION FOR BUILDIN; l't;KMIT OR MOBILE HCME USE
NaTE: No permit will he issued until this application has been approved.
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1WP I 7 RAN;E CJ 3 SEC.3 i . J . ~ TAX 1m if ''<00 CODE /9 03 CENSUS TRACl', ~ -/ C;)')-'
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wr NO. BLOCK SUBDIVISION
, , ' PROl'tJuy SIZE
ACCESS ID PRul'lli'IY c9-a. rdtiJ tAl fLY 'i?, WIDTH P J- Dill:' nI 1)..- t OR ACREAGE
DESCRIBE EXISTIi'G STRUCTIJRES ON TIlE PRldt'tKI'Y 5' ;:: 1\ _ _
APPLICANT , / / L:;) r MAlLIN} , ,,~ ~~' /' '
NAME ,C:; r~~/ J? 1\- J /' l':" ADDRESS -.02 /J X ~ ~ 1/ ~ ~ mE b k. /)... / r
CDNI'RAL'lUK' I - - MAlLIN; -- ,
NAME S A-;(A .p ADDRESS PHONE
BELOW FOR OFFICE USE ONLYirlrl~nb\h~A~Ah~~A~~~~~hhh~A~h~~~bn~~~~~~~~~~hhA~~~A~~~hA~A~~A~~~~A~~A~~~~
Structures to be built/Mobile Horne
sq. ft.
ifbedroarns
valuation
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Sewage Disposal:
Site Inspection if Existing sewage disposal system 0 or new system required 0
Water Supply:
Public 0 District Name Well 0 Spring CJ OthE?r/
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Bldg.
Waste Dis.
Phunbing
Plan Review
Trailer
1% surcharge
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Fees //
Plumbing Installed by CMner Otheu/ Name:
Plumbing Fees ' Sewer conn6ction Water connection
if of fixtures inspect'~n fee ,inspection fee
n Caffi:Y" Plans ished Facility Permit
{d-eheck Yes 0 0 0 I r 6~s 0 Nq .0.
Signatur7 of Appl'cant '~(J~ A~ e~tect-12;'i
TaTAr. Is' ~OO Fee recelved by ~/ ptja' e Ch---!2 -7,/ /'
Min. Septic tank capacity Drainfield req~~ ( ,
with dist. box, Gallons IDa ~Lineal Fe/l;- Trench Depth ')J./! or Sq. Ft. 3b~
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Fire Zone
Type of Structure
Occupancy
Use Classification
Blgd. setbacks-ft. from center of road right of way
Front Side Int. Side Exterior Rear Zone
~h9hLf dat~~ &'~~:J_tt':.;
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Planning
date \~
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C55-12