72-T-35LICATION FOR A
For "~fice Use Only:
Case No.,. .,. ,' -' ~
Zoning , E ' Z.~ ....................
USE PERMIT
TO PARK A MOBILE HOME
(NEW AND RENEWAL)
(Following info/~on is to be typed or printed)
Name of Applicant: ~.J-~ %EAI~.[~.,,L ~X~/~
(Must be owner & OccuPant-of the Mobile Home)
Address of Applicant ~/ /~ ~,,'~. ~ Telephone ~'~$~/
Mailing address where mobile home will be located
'Magisterial District~~/.~,. Tax Map No, I E~ ~ ~_:~
Subd. Name ~~,~. Lot or P~cel ~ Blk. ~ Sec
A map of this property must be attached to this application.
This map must be to scale.
Name of owner of property on which mobile home will be parked
(If the'aPPlicant is not the owner Of the property in question,
explain.)
5. If mobile home will remain unoccupied, explain
Time requested for mobile home to remain at site (use permit
granted for a maximum of two years only.) ~[_
mOnths / years
7. Size and type of mobile home to be par~ed o~.,t,b¢,above noted
property. Make--Model ..~' Color~,~...Width t'~ (~r./
Length ~-(~} No. of Bedrooms ~ No. of Bathrooms /
8. Source of water supply ~,~,~'7"'¢-
Method of sewage disposal ~~t~ ~.~l~.)~ ~~' ,
* Information obtainable from the office of the County Assessor.
(Room 2lB)
9. Information, addresses, and signatures of all property owners,occupants
who are adjacent to the parcel on which the mobile home be located must
be provided in the spaces below.
We, the undersigned owners and occupants of the adjacent
property to the property on which a mobile home is proposed to
be located, hereby certify that we do or do not object to the
granting of a Use Permit to park a mobile home on the property
described in this petition.
Information available from the office of the County Assessor (Room 213).
Name (print) ~.~/'J
Tax Map No./~_~._~
Address:
I do object
( )
Signature
Check One 0nl~
I do( ' n~) J ect
~/g~o;,~2/3~O_~wner ( )~/Occupant ( )
Block No. Parcel No.
Name (print) Z~/~/-Z~-~ /~ ~.~//~,z/ Owner (~') Occupant
Tax Map No. /c~-~ ~ Block No. Lot or Parcel No....~
Address: ~ d~/~'/~/~ ~~- ~/~ ~ C~
Check One Onl~
I ¢.o~ect I do not object
Name (print) ~//"~U/~)~ ~/~,~',~0/; C~wner (~ Occup~t ( )
Tax
Map
No.
Address:
I do object
( )
Signature
Check One Only
I do(not .~)bJ ect
Additional spaces on back of page.
(2)
Address:
Check One Only
I do object
(
N ame(print~/~)~/~ ~,~. ~~/~
Tax Map No. ~/~-,~ ) ~) Block No,
Address: ,,~/~j~ .~.~,~.~ ~ ~.-~..~..
Check One Only
I do object -, '~ ' I do
· (/~~ ,: ,-~ (n oct
Signature.
-
I do not ~ect
Owner ( ) Occupant (Z-~
Lot or Parcel No.
Name (print),
Tax Map No.
Block No.
Owner ( ) Occupant (
Lot or Parcel No.
Address:
I do object
(
Check One Onl~
I do not object
( )
Signature:
Name (print) ....... Owner ( ) Occupant ( )
Tax Map No,
Block No,
Lot or Parcel No.
Address:
I do object
( )
Check One Only
I do not object
( )
Signat ute:
(3)
The Chesterfield County Health Department must make an inspection o£
the proposed mobile home location, both before and after the mobile
home is installed. It is the applicant's responsibility to contact
the Health Department and make an appointment for this inspection
(telephone - 748-1B98). The inspection Form must be attached to this
application.
The Applicant and/or his agent must be present at the Board hearing.
I/We hereby certify that all of the above statements and the statements
contained in any exhibits transmitted herewith are true. Further, that
all owners and occupants of adjacent property have signed Section No. 9
of this application and have been notified of the date and time of the
hearing.
Subscribed and sworn to before me this
My Commission expires ~. ~
f~Not a~ Public
-4-
~quest for Lot Bvaluation
For ~
Phone
O~-~ner
Addre~ss
Lot BlOck S~ction Street ~ ub'div"i's ion
Applicant /~Dgsires to have a lot opinion that is s%foj~ct to re--,
~valuation prior to issuance of Building P~rmito
/-7 Is applying for Building P~-rmit ~''
Type of Construction/
/~/ Dwelling ,/,?'/ Other ~,~6~/~--/L. /-7 HOUS~ plan not final
/~.uto. ~aSher /__~ Garbage Disposal /.~blic ~Tato, r./-7 Ind. '4ell
~.ctual or potential ~edrooms____~st~mat~d~ ~ '~ ' water consumption ~d~od.. , ......
oo~1 Study~
}:ecommandations~_ ~ _ Basad on pr~sent standards it is our opinion that
~hi~/~6t has ~ '
/ / FAVOP~J3~ / / ,,~u~S~I,~z,~LB~')' ';': ~:~ n~, - ~ /~ NOT SUITED
So'il for septic tank an~, drainfield instal~tion.
Tlxis~is not a oermit 'co' ii%'stali
Sanitarian ,- , , ,
Dat~
Posted Grid
6500~