HomeMy WebLinkAboutBLD1995-00292 1,,�
**JEFFERSON COUNTY
MOBILE HOME INSTALLATION PERMIT APPLICATION
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BUILDING TYPE
MOBILE X NEW BUILDING
,4 " 6 X / El REPLACEMENT
SIZE 6 « 6r
YEAR /9 95
MAKE 6/l... iz.,/6reCt 57-.
COST 4%6 goo.
DESCRIPTION OF IMPROVEMENT: _ AR A) L: �Pz_4 , AJy
TYPE OF SEWAGE DISPOSAL: X INSTALLED 19(14
❑ SEWER X INDIVIDUAL SEPTIC
Permit Number: SEP -
TYPE OF WATER SUPPLY: PRIVATE %DRILLED WELL OTHER
PUBLIC ❑ CITY OTHER:
NAME
❑ PUD STATEI.D.
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS NUMBER OF PROPOSED BATHROOMS
TOTAL NUMBER OF BEDROOMS TOTAL NUMBER OF BATHROOMS !_ ---
IF
WATERFRONT PROPERTY, NAME OF ADJACENT BODY OF WATER ,/C BA
BANK HEIGHT /6'"s FT SETBACK .5C2 ' O A FT
IISIGNATURE _& jyt DATE Via"' 3 ,
APPLICANT NAME (PLEASE PRINT) 6 ,...elveG
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*************************************,FOR OFFICE USE ONLY****************************************
BASE FEE /Z
ADDITIONAL SECTIONS RECEIPT # A)7 3 c
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STATE SURCHARGE I DATE � Q/ / l,S
TOTAL /, 9, 6-0 CASH/CHECK 6, 9 44
Planning Area Fire District School District 7
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