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MARION COUN'r~ BUIEDING INSPECTION <br /> <br />BUILDING [~/ MOBILE HOME [] <br /> <br />SEPTIC [] <br /> <br />Tax Lot <br /> <br />Site No: <br /> <br /> Contract City:: <br /> <br />~n~on Type;: <br />Subdivision:: <br /> <br /> Min Reqd Front: <br /> Setbacks:: <br /> <br />PERMIT APPLICATION <br /> <br />UGH: <br /> <br />Occupancy:: <br /> <br />Cro~e Street:: <br /> <br />Occupant Load' <br /> <br />I L eft Right L Rear:: <br />Side Side:: <br /> <br />Lot:: <br /> <br />Width <br /> <br />Block:: <br /> <br />Depth <br /> <br />Sectioe;; <br /> <br />Township:: <br /> <br />Range:: <br /> <br />Irreg, Lot <br /> <br />New:: [] Addition:: [~ Demo:: [] Tach <br /> <br />After:: [] Relocation:: [] Occ Chg: [] Review:: [] <br /> <br />Map:; <br /> <br />Fleet S/C Zone;; <br /> <br />Use of Building:: <br /> RES [] <br /> COM ~ <br /> <br />A~chitect / Engi.~eer:: <br /> <br />Height of Building NO Stories <br /> / <br />Mobile Home Width <br /> <br /> Phone:: <br />Sq,, Fl, Main <br />Length <br /> <br /> Address:: <br />Sq Ft 2nd Floor:: Sq,, F't Garage:: <br /> <br />Water Supply~__~, <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 /> Type of System:: <br /> Date Tank Pumped:: <br /> <br />Valuation:: <br /> <br />I ~ ) I have read this application in its entlreP/and certify that the stated information is true and corre~ to the best of my knowledge <br /> <br />( ~ ) ThewerkwJllbeperformedbyaregistemdbuilde~ <br />() Other. <br />( ~. ) I agree to build according to the submiffed plans and $,pe~iflcatt.¢~, the laws of <br /> <br />OTHER PERMITS REQUIRED~' THIS DEPT.: PL U M BIN G, ]~.C~[/~Ue~L, ELECTRICAL <br /> <br />Mobile Home Fee:; <br /> <br />Fleet Surcharge:: <br /> <br />Zoning Sumharge~ <br /> <br />State Sumharge:: <br /> <br />Plans Check Fee: <br /> <br />Site Evaluation Fee:: <br /> <br />Septic Permit Fee;; <br /> <br />DEQ Sumharge:: <br /> <br />Technical R~iew Fee, <br /> <br />Reinspectlon Fee:; <br /> <br />RECEIPT NO <br /> <br /> <br />