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MARION~:~OUNTY BUILDING INSPECTION '-c~ty Setback R~quirements; <br /> <br /> Senator Dldg. No, 225 <br /> 22o High S~eet NE <br /> Salem, Oregon 973el <br />Date: q"~ ~ "~ ~ ~"' <br /> ·"" ' ,~ ~ Phone 58~5147 <br /> ~. ' ' , '. ~' Cod~A-Phone 4:~0 RM, - 8:00 ~ <br /> <br />PropcrJy Owner; ' <br /> <br />Job Address: <br /> <br /> ~,~,a~ t1-~ <br /> <br />Front; ~ Rear; ~ / <br /> <br />Left ,~ / Right ,~ / <br />Side: J Side: <br /> <br />Phone; <br /> <br />Site No,: <br /> <br />PERMIT APPLICATION <br /> <br />F..ailing Address: <br /> ~, ~ <br /> <br />Property Tax Lot NO.; <br />.5'??//- <br /> <br />Fleet SIC Zone: <br /> <br />Subdivision: Lot: Block: <br />Mobile Home Park: Sp, #; Total # Spaces: <br /> <br />Lot Width; Lot Depth: <br />,,,,,~, 0""6 ',,;~-- '~/ ~ Acres: <br /> <br />Zone: Map; <br />bfog. L t: Gorne <br /> <br />T <br /> <br />Contractor SusJnees Name and - <br />Architect/Engineer; <br /> <br />Phone: <br /> <br />Address; <br /> <br />Address: <br /> <br />/~e of Permit: <br /> <br />New: <br /> <br />Alter; <br /> <br /> __:: __: ~ I~/'~ ..... I LO', ~ <br /> / ~ ~¢~.~----~,., ¢ ....... ~ <br />Mobile ~e [ ~ Bedrooms; J Occupancy: Occupant Load'. [Water Sgpply: j <br /> <br />Height of Building: <br /> <br />Mobile Home <br />Width: <br /> <br />Proposed Septic Installation: <br />Previous Site EvaluatiOn #; <br />Type of System; <br />Test Holes Ready; <br />Will call when holes reedy: Proposed Bedrooms: <br /> <br />Existing Septic System: <br />Existing Tank Size; <br /> <br />Existing Drainfleld Leng!h: <br /> <br />Type of Syetem: ~,~j <br />~.B_.a~e_~-~k Pumped: Existing Bedrooms; .... <br /> <br />) Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 12/87 <br /> <br />Mobile Home Fee: <br /> <br />Zoning Surcharge: <br /> <br />State Surcharge: <br /> <br />Plans Check Fee: <br /> <br />Site Evaluation Fee; <br /> <br />Septic Permit Fee; <br /> <br />DEQ Surcharge'. <br /> <br />Technical Review Fee; <br /> <br />Reinspe~ion Fee; <br /> <br />Investiga~n Fee; <br /> <br />City Fee; <br /> <br />TOTAL FEE; <br /> <br />RECEIPT NO.: <br /> <br /> <br />