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'~ !. ~) · ,~! ,~ - 'MARION COUNTY BUILDING INSPECTION <br /> <br />ICity Setback Requirements: <br />Front: y~_ [4Rear: <br />LSiOe: ~ ISide: <br /> <br />BUILDI~ MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Job Address: <br /> <br />Subdivision: <br /> <br />Property Owner: "' Phone: Mailing Address; <br /> Site No.: Cross Street; <br /> Fleet S/C Zone; <br /> Block; <br />Mobile Home Park; Sp. #: Total # Spaces; <br /> Zone; <br /> <br />Property Tax Lot No,: <br /> 4-0 ¢.¢% c> c> o <br />Lot'. <br /> <br />Township: <br /> <br />Range; <br /> / ~ <br /> <br />Map; <br /> <br />Lot Width: Lot Depth; Acres: Irreg. Lot: Corner: <br />~/'¥Q /omo /c~ -f- o~. - <br /> <br />Contractor Business Name and No,: ;~ "2 5'~¢ ~ <br />Architect/Engineer: <br /> <br />Phone: <br /> <br />Address: <br /> <br /> e of Permit: New: [] Addition; [] Demo; [] Tach. Use of Building; RES [] <br />~.p"'f'l. ~ Alter: ~ Relocation; J~ Ccc, Chg,; [] Review: [] COM J:~ <br /> <br />Height of Buildlng; Sq. Ft. Main Floor: Sq. Ft, 2nd Floor; <br /> <br />Mobile Home # Bedrooms: <br />Width: <br /> <br />No, Stodes: <br /> / <br />Mobile Home <br />Length: <br /> <br />OccupanCy; <br /> <br />Sq, Ft, Garage: Other: <br />Occupant Load: [ _Water Supply: <br />......... <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation ~; <br /> Type of System: <br /> Test Holes Ready: ~/ <br /> <br />Wltl call when boles ready; <br /> <br />Existing Septic System: <br />Existing Tank Size: <br /> <br />.~posed Bedrooms: <br /> <br />Existing Drainfield Length; <br /> <br />Type of System: <br />Date Tank Pumped; <br /> <br />Existing Bedrooms; <br /> <br />( ~ ) Ihavereadthieapplicationinitsentiretyengcertifythatthestatedinformationis <br /> true and correct to the beet of my knowledge, <br />( ) I am performing work on a property I own er occupy. <br />( ,,~ ) I am a reolstered builder OR ( ) the authorized representative of a registered <br /> <br />( ~ } Tho wore will be performed by a reglsteres bulldo~ <br />( ) Other <br /> <br />agree to SUilO accorotng to tho submtaod plans and specifications, the laws of <br /> <br />OTHER pI~RMITS REQUIRED BY THIS DEl33'.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15.6 <br />Rev, 12/87 <br /> <br />Bldg, Fee: $. <br />Mobile Home Fee: <br />Fleet Surcharge; <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Check Fee; <br />Site Evaluation Fee; ....... <br />Septic Permit Fee: <br />DEQ Surcharge; ¢ .5. ~ 0 <br />Technical Review Fee; <br /> <br />Reinspeotion Fee; <br /> <br />Investigation Fee: <br /> <br />City Fee; <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO,; <br /> <br /> <br />