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Rece~e.d By: ~,~ <br />City <br />Zoning Validation; ....... <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator I~ldg, NO, 225 <br />220 High Stree~ NE <br /> Salem, O~:Jon 97301 <br /> <br /> Phone ~-5147 <br /> Code. A-Phone 4:30 RM. - 8:00 A.M, <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br /> etback Requirem~_ts: <br /> Rear; <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner; <br /> <br />Job Address; <br /> <br />Phone; Mailing Address: <br /> Bite N°l:/i r] <br /> Property Tax Lot No,; <br /> <br />Cross Street; <br /> <br />Fleet S/C Zone: <br /> <br />Subdivision: Lot: Block: <br />Mobile Home Park: Sp, #: Total # Spaces: <br /> <br />Contractor Business Name end NO.: <br />Architect/Engineer: <br /> <br /> Address: <br /> <br />~-.-~-Z? <br /> Address: <br /> <br />Type of Permit; <br /> <br />New; ~ Addition: [] Demo: [] Tach, <br />Alter: ~ Relocation: E] Ccc, Chg,; [] Review; [] <br /> <br />Height of Building: NO, Stories: <br /> /~" / <br />Mobile Home Mobile Home <br />Width; Length; <br /> <br />Type of System: <br /> <br />Sq, Ft. Main Floor: Sq, Ft. 2nd Floor: <br /> Bedrooms: Occupancy: <br /> <br />Test Holes Ready: <br />Will call when holes ready: Proposed Bedrooms: <br />Existing Septic System: <br />Existing Tank Size: <br />Existing Drainfield Lengt~ <br />Type of System: <br />Date Tank Pumped: Existing Sedrooms: <br /> <br />I <br /> <br />Use of Building; I RES [~ <br />Sq. Fl, Garage: Other'. <br /> <br />Occupant Load; <br /> <br />Water Supply: <br /> <br />Mobile Home Fee: <br /> <br />Zoning Surcharge', __'~' ~5 <br />State Surcharge: __3-' "~) <br /> <br />'-.'~ I have reed this application in its entirety And codify that the stated information is <br /> true and COrrect to the best of my knowledge. <br /> I am performing work on a property I own or occupy. <br /> <br />Site Evaluation Fee; <br />Septic Permit Fee; <br />DEQ Surcharge: <br />Technical Review Fee; <br />Relnspection Fee: <br />Investigation Fee; <br />City Fee; <br /> <br />TOTAL FEE'. <br />RECEIPT NO,; <br /> <br /> <br />