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Received By: <br /> <br />Zoning Validation; <br /> <br />Bate: <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />~enator Bldg, No, 225 <br />g20 High Street NE <br /> Salem, Oregon 97~01 <br /> <br /> Phone s88-5147 <br /> Coae~A-Phone 4:30 RM. - 8:00 A,M, <br /> MOBILEHOME ¢ SEPTIC [] PERMIT APPLiCATION <br /> <br />"se°t"ui b <br /> <br />Mailing Address; <br /> <br />Tax Lot; <br /> <br />Site No, <br /> <br />Contrac~,~City; UG2 <br />Construction Type: Occupancy: <br /> <br />Subdivision; <br /> <br />Cross Street: <br /> <br />Occupant Load: <br /> <br />Lot: <br /> <br />Width; <br /> <br />Min. Reqd, Front; <br />Setbacks; <br /> <br />Block: Section <br />Depth: Area: <br /> <br />Township: Range: <br />Acres: [ Irreg. Lot: <br /> <br />'" Rear; <br /> <br />l Left Ri ht <br />Side; Si~e: <br /> <br />Zone: <br /> <br />Map: <br /> <br />Fleet B/OZone: <br /> <br />Type of Permib New: ~f Addition: C~ Demo: I~ Tach, <br /> <br /> Alter: [] Relocation; [] Occ, Chg,: [] Review: [] <br /> <br />Contractor: Phone: <br /> <br />UseofBuilding: .f I RE <br /> <br />Home Builder% Registration NO,: <br /> <br />Architect/Engineer: Phone: <br /> <br />Address: <br /> <br />Height of Building: No. Stories: Sq, Fl, Main Floor: Sq. Ft. 2nd Floor: Sq. Ft. Garage: <br />MobileHome: 7~/t~h.'/[/~ Length:~..~,,~) WatarSuppl~. <br /> <br />Other: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation ¢; <br /> <br />Type of System: <br />Test Holes Ready: <br />Will call when holes ready: <br /> <br />Existing Septic System: <br /> Existing Tank Size: <br /> Existing Drainfield Length <br /> <br />Type of System: <br />Date Tank Pumped: <br /> <br /> is true and corm~ ~ the best ~ my knowledge. <br /> <br /> a registered builder. <br /> The work wltl be pedormed by a registered builder. <br /> <br />I agree to build according to the submleed plans and specifications, the laws of <br />the state of Oregon and the ordinances of Marion County. ~ / <br /> <br />Valuation; <br /> <br />$ <br /> <br />c ¢- ?7- g/ <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev, 3/87 <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee; <br />Fleet Surcharge; <br />Zoning Surcharge: <br />State Sumharge: <br />Plans Check Fee: <br />Site Evaluation Fee; <br />Septic Permit Fee; <br />DBQ Surcharge: <br />Technical Review Fee: <br />Reinspection Fee: <br />Investigation Fee; <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br /> <br />