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Reo,eived By: ~~*, <br />Zoning Validation: <br /> <br />BUILDING [~MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bids, NO. 2~g <br />220 High Stmet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4;30 RM. - 8:00 A,M, <br /> <br /> SEPTIC [] <br /> <br />Property Owns'; -- <br /> <br /> Setbaok Requirements: <br /> r <br /> <br /> pFRMIT APPLICATION <br /> <br />Phone; Mailing Address; -~¢¢"4 <br /> <br />Job Address; <br /> <br />Subdivi~oJe '. <br /> <br />Mobile Home Park: <br /> <br />Site Ho.: <br /> <br />Property Tax Lot Ne.; <br /> <br />Sp. #: <br /> <br />Zonep/~ Map; <br />Irreg. Lot; Corner'. <br /> <br />Cross Street: <br /> <br />Fleet CiO Z~e: <br /> <br />Block; <br /> <br />Total # Spaces; <br /> <br />tracto? Business hJame ~[nd No.: Phone: Address; ] <br /> /¢'. z <br />AF~'~itect / EnClin~ r; ..... Phone: Address: " <br /> <br /> Addition; [] Demo: <br />~)/.~ Al'~er; [~ Relocation: [] Ccc, Chg.: <br /> <br /> Height of Buildlr~g; ! No. Stories: Sq. Pt, Main Floor: <br /> j t 9?.5-' <br /> Mobile Home Mobile Home # Bedrooms: <br /> Width: Length: ~,/ <br /> <br /> Tech. Use of Building; <br /> <br />Sq. Pt. 2nd Floor'. Sq. Ft. Garage; ~ Other: <br /> Occupant Load; <br /> <br />Occupancy: <br /> <br />Type of System: <br /> Holes Ready; <br /> <br />Will c~,lJ when holes ready; Proposed Bedrooms; <br />Existing Septic System: <br />ExistJgg Tank Size: <br /> <br />Existing Dralnfield Length: <br />Type. qf System: <br /> <br />Date Tank Bumped: Existing Bedrooms; <br /> <br />( %t~ ) I have read this application in its entirety and certify that the stated information is <br /> true snd correct ~o the best of my knowledge. <br />( ) I am perforrclins work on a property I own or occupy. <br /> <br />Valuation: <br />BId~. Fee; $ ~33, ~ <br /> <br />Fleet Surcharge: '--~ ,¢P¥/~ ...... <br />Zeroing Sumharge: <br />State Surcharge: /~ ~ <br /> <br />Site Evaluation Fee: <br /> <br />Septic Permit Fee; <br /> <br />DEQ Surcharge: <br /> <br />Technical Review Fee: <br /> <br />Reinspe¢;on Fee; <br /> <br />Investigation Fee; <br /> <br />TOTAL FEE: ~/~' ~_. <br /> <br /> <br />