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HomeMy WebLinkAboutSpecial Inspection Septic Tank 1974-9-13 ~~ , ' \ ,. '~J;'~T:ffJYC("""-- II lANE' COONTY ' . , ' , .' Building)Z.) DEPAR'lMENI' OF ENVIRONMENTAL MANAGEMENT Mobile 'Home APPLICATION FOR BUILDIN;.t'l2<MIT OR MOBIlE HCME USE 'f'lULt..: No .pennit will be issued until th:f-s application has been approved. ~EflUm, ' PRu.t'lli1YLOCA~ON' ~ t'OS'O I r;.;4-/Cd.e-A.I t-JA-y I .' . , \ \ 1WP /7 wr NO. ' mr;E () 3 BLOCK SEC.3l/, :;1,3 TNA wr if. 3 (16 SUBDIVISION COD~L9'~J CENSUS TRAGI' 3 -/o? , PROn.L~Ti SIZE ACCESS':ro PRu.t'lliTISo. Gi4-fi-Jc:JJ, t.J 11- i Wilin! ' , DEt'nI DESCRIBE ExISTIN; STRUClURES ON THE PROPEkrY Il tV€.- /-(.,,/ /L{ 6...- APPLICANT MAILIN; SO'lrf\.1 ~I NAME /Jr.>f.lG- CO? e-ADDREsS t C6!Y;.lJiZJ etJ WA-V_PHCNE OONI'RAl.;l;.lK. /J MAILING' // ' XNAME ~'(~Ss:~.e:LL U\f}()/}-ris Au1JKr13S7;lh:{q$/(J~ L--.(I. PHONE~R9'-o(.,17 BELCMT FOR OFFICE USE ONLY-,'ddd(';\I'. ;,:,;,.\,\ I,i..\ ..'n'(-k-Jdn~k"'^*kJd(')"'k-:ddddn'n~'&-J.-J~.!Jn'n'~'kl(')"':dn'd~)";,;, ldnb'd<"lnb'(1(-. Stn~tures to: be bUl,'lt/MobileHome ). , 'sq. ft. r.v. ifbedroorns valuation, .d-t) /lA'L./~ 1L- '- ~~ <;/- -::2, ~ ' r;, :;L ~ '0; 30 ~~, 133. 7 t o ',', ,,} . A_.d." -i':Jt. I' '''L!' rx:f IJ1., ./IU-Jn.tA' , \.'3 3 6 ... I :: I OR ACREICE TarA!.. /' / Existing sewage disposal system ~or new system req~ 0 Well~S~ring 1:1 Othe~' , Fees ~ ~ t- Plumbing Installed by CMner Other Name: CbC:~ Plumbing Fees ,Sewer conn tion Water connection ~ iF. of fixtures inspecti fee~. inspection fee ::L , .:5 ~ 0 Ca~, " . Plans~' 'ed' Facility Pennit , \B"'Cfieck Yes& No , ~ Yes 0 N9.?~ 0' ' Signature of Applic t" 'j ~Au4h1/// tt. '--0/~te ~ :J u ,3$ , ,Fee received b~ _ / I da.te_~fi~/;,y Drainfi~ld required, / .. Lineal ~eet ji'rench Depth or Sq. Ft. \ / , ! Type otStructure 51( Occupancy ~ire Zone I Use Classitication .. ' / Blgd. s, etbacks-ft. from cente~f road righ,t % way Front ~tJ Side Int., ' Sidet:Xterior.-. Rp;:Jr,~ 'Zone 46. / Planning date sanit1~~" , ! I date Building , ,'/f?// ,date' -.l ~ 9- r~-7Y- -~~ <J//6 ,7'1 UJ ~(~ Q"/7-7{/ ',' ' C' " f. > .>: _: I . ' Sewage Pisposal: Site Inspection if Water Supply: Public 0 District Name Bldg. Waste Dis'. Plumbing Plan Review Trailer , 1% surcharge & f. 0 () ~ ' r) 0 Min. Septic tank capacity with dist. box: Gallons C55-12