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Date'. /d-d/-& MARION COUNTY .aD.eSe-s147 <br /> BUILDING INSPI:C 01¢ <br /> BUILDING [] MOBILEHOME [] SEPTIC [] PERMiT APPMCATION <br /> <br />Situs Address: <br /> <br />Us, gt of Building;, <br /> <br />Tax Lot; <br />Site No.: Cross Street; <br /> <br />Contract City: UGB; <br />Constructio~n Type; Occupancy.: <br /> <br />Subdivision:._., . <br /> <br />Min, Reqd, Front: <br />Setbacks: ~ / <br /> <br />OccupentLoad: <br /> <br />Width: Depth: Irreg. Lot: <br /> <br />Left ~.~"'" Ri ht , Rear: <br /> <br />Zone~,~)_,~' . Map: <br />Cor~,(~ Fleet S/C Zone: <br /> <br />TyRe of Permit:. New'. [] Addition; [] <br />,,~-'~,~J AIter~ [~ Relocation; [] <br /> <br />Centre~r: ~ _ _ <br /> <br />Demo; [] Tach. <br /> <br />Occ, Chg,; [] Review; [] <br /> <br />Use of Building; <br /> <br />Address; <br /> <br />RES <br /> <br />COM [] <br /> <br />Home Builder's Reg.~7 No.: <br /> <br />Phone; <br /> <br />Height of Building; <br />Mobile Home: <br /> <br />Sq. Ft. Main Floor: <br />Length: <br /> <br />Proposed Septic installation: <br /> Pn~vlees Site Evaluation Cf: <br /> Type of System; <br /> Test Holes Ready: <br /> Will cell when holes reedy: <br /> <br />Existing Septic System; <br /> Existing Tank Size: <br /> Existing Dreinfield Length: <br /> '~'pe of System: <br /> Date Tank Pumped; <br /> <br /> Sq. Ft, 2nd Floor: Sq. Ft. Garage: <br /> <br /> ' Water SU~piy; ..~., <br />/.I. <br /> <br />Other; <br /> <br />Valuation: <br /> <br /> ~/)) t have read this appJicstion in its e~tirsty and cergfy thst the ststed in~rmetion <br /> v,~) ls true and correct to the best of my knowledge. <br /> I am performing work on a property I own or o~upy, <br /> I am a registered builder OR ( ) the authorized representative of <br /> a registered Puilde~ <br /> The work will be performed by a registered builder, <br /> Other. <br /> ~ I agree to build a¢~ocdlng to the submitted plans and specifications, the laws of <br /> <br /> / ',,/~, ~ <br /> / <br />OTHER PERMI~ REQUIRED BY THIS DEP'E.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev, 3/87 <br /> <br />Sldg, Fee: $. ~.~-b'~ O0 <br /> <br />Me,He ~o~e ~ee~ <br />Fleet Surcharge: "~' '~' ~ <br />Zoning Surcharge: <br />State Sumharge~ /"~ ..... <br />Plans Check Fee; /~- ~-- <br />Site Evaluation Fee: <br />Septic Permit Fee; <br />DEQ Sumharge: <br />Technical Review Fee: <br />Reinspectlon Fee: <br />In~stigation Fee; <br /> <br />TOTAL FEE: ~7~7 <br />RECEIPT NO.: ~g ~ <br /> <br /> <br />