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INSPECTION <br /> '~// ~l~/~ L~ U ~/ L~L~.,ag.,o.225 . <br /> <br /> ' /~// '- -- ~ ~ -, - d ~O~on ~301 <br />.~_ ~ ~ ~ ' L., ,; I .'. ,~ 1~87 <br /> <br /> .E.,C <br /> <br />Site No.; C~ss Street: <br /> <br />Situs Address: <br /> <br />Usa of S uilxd.~n~g: <br /> <br />Mailing Address; <br /> <br />Lot: Block: <br />Width: Depth: <br /> <br />Area; <br /> <br />Contract City: <br /> <br />Construction Type: <br /> <br />UGB: <br /> <br />O.~1.~ncy: <br /> <br />Occupant Load: <br /> <br />SubdNJsion: <br /> <br />Min, Reqd. Front: Left Right /" <br />Setbacks; ~ Side: ~*"/ Side: ,~ <br /> <br /> Irreg. Lot: Corner; Fleet SIC Zone: <br /> <br />T~pe of Permit; <br /> <br /> on r cter: -- <br /> <br />New; [] Addition:~J~/ Demo: [] Tach, <br /> <br />Alter; [] Relocation: [] Ccc. Chg.: [] Seview; [] <br /> <br />Use of Building: <br /> <br />COM [] <br /> <br />Home Sullder~ <br /> <br />Architect/Engineer: <br /> Ho. Tdes'. <br /> <br />Mobile Home: Width; <br /> <br /> Phone; Address; <br /> <br />Sq, Ft, Main Floor:~ ~c,~ t~! Sq, Ft. 2nd Floor: Sq. Ft. Garage: <br />Lengthi ~"~ WeterSupply; ~.~g <br /> <br />Other; <br /> <br />Proposed Septic Installetloo; <br />Previous Site Evaluation ¢: <br />'/'fps of System: <br />Test Holes Ready: Valuation: <br />Will call when holes ready: $ ~__.~)~, <br />Existing Septic System; <br />Existing Tank Size: <br />Existing Drainfield Length: <br />Type of System: <br /> <br /> D~te Tank Pumped; <br /> <br />( ¥ I have reed this application in its entirety and cenity that the stated information <br /> is true and correct to the best of my knowledge, <br />( ~ I am perforrning work on a property I own or occupy. <br />( Iarn a registered butlder OR ( ) the ~uthorlzed representative of <br /> a registered builder. <br />( The work will be pedormed by a registered builder. <br />( pc Other <br />( ~ I agree to build ac(;ording to the submitted plans and specifications, the laws of <br /> the state of Oregon and the o~dlnances of Marion County. <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELEC~I'RIC~'~' <br />MC 1 <br />Rev, 3/87 <br /> <br />Fleet Surcharge; <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 />Invest~igation Fee; <br /> <br />City Fee; <br /> <br />TOTAL F~EE: <br /> <br />REO~,PT.O.: <br /> <br /> <br />