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M Code-A-Phone 4:30 BM - $:C0 , <br /> <br /> BUILDING OBILE HOME [] SEPT ~PMCATION <br /> ' -'~1~ ,~. /VI ~ <br />Property Ow~r:] ~ ] <br /> <br />Job ~dre~s:' ~ ' ~ <br /> <br />MARION COUNTY BUiLDIN~I~'F-,~TLON [ ?.ty Setback Regulre..mems:_ <br /> 220 High Street N~ q ~E ~ '/%' '~ I ' ~ <br /> Salem Or.on 97301 ~ ~ I ~t I1 I l I Rig~ ~/ <br /> <br /> Phone; <br /> <br />Mobile Home Park: <br /> <br />~5zz <br /> <br />Site No.'," ~ td <br /> ~ _~'-q / <br />Property Tax Lot No.: <br /> <br />Lot; <br /> I <br /> <br />Block: <br /> <br />Section: ] LOt Dept%~.,.~. J Acres: <br /> Townsli~ ( Zone~_ <br /> <br />Phone: <br /> <br />Phone; <br /> <br />Address: <br /> <br />Contractor Business Name ¢ No.: <br />Amhlteci/l="ng'ineer: /L <br /> <br /> Type of Permit: New; [~ Addition: [] Demo: [] Tach. <br /> <br />~,~"~g; No, itories: I Sq. Ft. Main Floor: Sq. Ft. 2nd FIo~or: <br /> <br /> Width'. .~_ I LenCh: /~ <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation #; <br /> <br />Type of System; <br /> <br />Proposed Bedn~oms; <br /> <br /> Test Homes Ready.[ <br />Wlll call when holes ready: <br />Existing Septic System: <br />Exlstln~ Tank Size; <br /> <br />Existing Drainfield Length: <br /> <br />Type of System: <br /> <br />Existin~ Bedrooms: <br /> <br />.... _Date T~nk Pumped; <br /> <br />Use of Building: <br /> <br />B~dg. Eeo: <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 />Reinspection Fee: <br /> <br />Investigation Fee: <br /> <br />Gity Fee: <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO.: <br /> <br /> I am a registered builder OR ( ) the authorized representative OF a registered <br /> builder, <br /> The work will be performed by 8 registered builder, <br /> Other <br />t~:~the state of Oregon and tj.~[dlnances of Marion County. <br /> <br />OTHER PERMITS REQUIRED BY THIB DEPT,: PLUMBING~ MECHANICAL, ELECTRICAL <br /> <br /> <br />