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. . . . . . . . . . 7`LG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Plumber Well Driller <br /> S/.!.�.n. . . . . . . . . . . . . . . . . . . . . . . . . . S9 !?� . 2 . . . . . . . . . . . . . . . . . . . . . . -. <br /> Address Address o <br /> _» <br /> . . . . . .3. `/. `1:.S`/. / . . . . . . . . . . .. rZm.. .e. . . . . . . . . . . . . . . . . . . . . . <br /> Phone Phone tO <br /> � o <br /> o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities: o <br /> Type of Construction No. Bathrooms . . . . • Z Z ° <br /> 0 o v <br /> 1. Work ��// . . . . ,rt 6 S �. . . . No. Bedrooms - - . . - - <br /> New Building . . . Size ft. x . .3�. it. Septic Tank Size Gals. <br /> Addition . . . . . . Height . . . . . Stories . .�. . . <br /> 7a.Absorption Field Site: <br /> Sanitary :r <br /> . . . . . . Area . . . . . . . . . . . . . . . . . . . r <br /> Filling Soil Type :® o <br /> Moving . . . . . . S. Permits Required Slope <br /> Grading . . . . . . Subdivision Perc. Rate . . . . . . . . . . . . . . . . . <br /> Mobile Home . . . . . . Sanitary , , Dry Well <br /> Seepage Trench <br /> Privy Building • .. • .. yr <br /> Well . .X . Well _ _� . Privy . . . . . . . <br /> Subdivision . . . . . . Other (Specify) . . . . . . Seepage Bed . . . . . . o <br /> Conditional . . . . . . c <br /> 2. Classification Land Use . . . . . . cr » <br /> a <br /> Zoning Dist. .4, : ' = o <br /> 6. Use (describe exactly, 1fam. <br /> 3. Lot Size Q home, motel,etc.) FOR COMMERCIAL USE 0 <br /> �i ft.x . .�!.�. ft. Plans Submitted . . . . . . <br /> . . . . . . . . . . . . . . . . . . sq. ft. Plans Approved . . . . . . <br />------------- — — --- --------------- ------ <br /> Fig. A. r <br /> Location of proposed structures and � <br /> existing structures, well, se Nage sys- o <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side s <br /> and back yard dimension and location <br /> o7- and setback from all bodies of water. <br /> If property is located at a highway in- .� <br /> _ tersection, show the intersecting high- ^ <br /> ways and the setbacks requ red along <br /> 63O"`_5vf'Pb s them and at the intersectio i� <br /> - ` l 1✓J y ' e- 7� <br /> PERMIT FEES <br /> m <br /> -3Subdivision.....$25.00 + $2. 0 per lot. <br /> &J ^ O c r/ ��� —�� Land Use................................. <br /> 75' h�c;a rK Building.................................. <br /> rF Sanitary ....... 2 0� — <br /> We I I ........................................ 10. 0- <br /> c� Septic Tank ............................ 10.00 <br /> rz Privy ....................................... 5.00 <br /> 5 la le 7o <br /> ..�..... .. `... `................. ..�./...16�R .x ....c!r:: /=' mi's.r>.,.... ................... <br /> S ature o Owner or eejn��t Oa ing A m' ato <br /> Inspection Date ... -..Z..J.�.O..`.�................. Inspectorpp.( /.5:. .L............. ......................�. .... <br /> Remarks ...�.r�5 �r.✓S?�': ......... .l.. ..7. rZ .,..... �/ .r.. (. .: z?/. ..`. ..... <br /> .....G .... :.. .r...j ...... .... ...-� <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation,' test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any pl mbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE'IAND APPROVED. <br />