HomeMy WebLinkAboutPermit Plumbing 1995-6-23
NOTE:
NO PERMIT WL
BE ISSUED ~TiL THISAPPLICAT~S'
- --
, PERMIT if \ ~\\ ...J\~
BE~N,APPROVED
APPLICATION FOR:
. CO\:,RUCTIO' ~ \ I MOBILE HOME I. ,LAN REVIEW CljANGE OF oecu, ANCY
I I OWNER. Gb CJ... C GC" ') \ Q .
, , C' Name~' " ---p"ddrr s., ~ City I, ' Zip ,Phone
L\6 CONTRACTOR ~(""\~" y' C"ll"\'P ~'""("~,"€, ,-........'-'~~x~ OSOa..&II'k_
./ "'- Na~e, ~, ~ress, ' " y , Zip Phone
O.S. REG. '/I' ,. \..c8<1.. -\d..~
Twp. \ \\ Rangei..:;L ~ Sectio~ ~L\ ~~Tax Lot~ Code ,Census Tract ,~~ --/(fD
Subdivision \,,\q
\." '~. ( , .
ACCESS TO PROPERTY (Road 'Name) , _1, ~b '- c:\'O-"""" ~
Existing Structures on property:~.p C. ( ..... \) ,
Lot
Block
Property Acreage
Width
Depth
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;r~Y ~~LD:"tic'~j{\:;l~ ~-=c,,~~~" .
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/
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Below fo r Of f ic e Use OnlyXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
.... ~ { {, \ ( "- ~ Sq. Ft.. ~ IIBedrooms i\ V;9{~a7ion
-----x~ V fV\ ".:-\ - Cto,-,:-\ (~;. 6r' ,---Yo ~..\_~ "'<.\Y\.. ~q~ Q) \l{" \0 ::t:io~( L ~
. \)', ~ /
'/
/
SEWAGE DISPOSAL:~ \
Site Inspection ac ,J)( \' ~ .
Existing Sewage Disposal Syste~
Spring
Other'
I
. Co~unity I
Public,
/ ..'
I or New System Required
'orne of C~Y 0' 'ub1'. Sy"em
Bldg.
'Waste Disp.
Plumbing
Plan Revielo1
\-.\~~
PLUMBING:
Installed by Owner
'\
'Water
Connection
Other
1% Surcharge-
PL~~~S: ,
'\ \\ II of Fi~tures "
~t)1 ~,. .
l..\n,~U LJLJ ~~
", _ FACILITY PERMIT /-
I l/, ES I ,I NO #' I "I?) IV I NO
Sign ture of APPli~..-{1" '<f? ~ ~
Fe Received By: (~~ate:f--...\~\O~
Mobile Home
TOTAL
Type of Construction
/
. J /
c5 AI Group
DrainfiJld Required -'L neal Feet
~),.j, 1.., /6 ft." -f:"
\ /
/ "j
~.! -Ve Zone
Maximum Depth
Min. Sep~~k Capacity
, I.di::F-- ff<...eo n..eu)
'-'" ........... V,
>-95,
Use Classification
Bldg Setbac~s - from Center of Ro~d Right of Way: . Ii I /
Front 00 Side Int. ~ I Side Exterior IV fla-
t I
Rear
Ze
Zone l~t~T
C55 - 12
r../ '1-1' t; .
I NE ' COUNTY
SAmt:
DEPAQ'CE:T.....OF
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~/':J' ~y~t. & ~/lP
ENVIRONMENTAL ~NAGEMENT I' ,
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