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Received B~. <br /> <br />City <br />Zoning Validation:: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. No. 225 <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />ICity Setback Requkement~:: <br /> <br /> Froot;; Rear; <br /> <br /> Left Right <br /> Side:: S de' <br /> <br />BUILDING [~ MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br /> Property Owner:: Phone: Mailing Address: ..... <br /> <br /> Job Add/ess:: Site No,,:: Cross Street:; <br /> Property Tax Lot No,,:: <br /> <br />Subdivision:: Lot:: Block:; <br />Mobile Home Park:; Sp ~:: Total # ~p~ses, <br />Section:: Township! Range:: Zone:: Map:: <br />.... Lot Width:: Lot Depth:: Acres:: Irrag Lot: Corner:: <br /> <br />Contras or Bus ness Name and No <br />Architect/Engineer:: <br /> <br />Phone:: <br /> <br /> '73 <br /> <br />Phone:; <br /> <br />Address:: <br /> <br />Type of Permit, New: [~ Addition:: [] Demo:: [] <br /> Alter: [] Relocation: [] Ccc, Chg,: [] <br /> <br />Height of Building:: <br /> <br />Moblte Home <br />Width: <br /> <br />No, Stories:: Sq Ft Main Floor:: <br /> <br />Mobile Home # Bedrooms: <br />Length: <br /> <br />Tach, <br /> <br />Review- [] <br /> <br />Sq Ft 2nd Floor;: <br /> <br />Occupancy:: <br /> <br />Use of Building:: <br /> <br />Sq,,Ft Garage:; <br /> <br />Occupant Load:; <br /> <br />RES ~ <br />COM [] <br /> <br />Other;; <br /> <br />Water Supply:: <br /> <br />Proposed Septic Installation;; <br /> Previous Site Evaluation #:: <br /> Type of System: <br /> <br />Test Holes Ready: <br />Will call when holes ready;; Proposed Bedrooms; <br />Existing Septic System;; <br />Existing Tank Size:: <br /> <br />Existing Dralnfield Length;; <br />Type of System:: <br />Date Tank Pumped:: <br /> <br />Existing Sedrooms:: <br /> <br />(~:~ { have read this application in its entirety and certify tlqat tl~e stated information is <br /> true and COrreCt tO the best of my knowledge. <br />( ) I am pedorming work on a ~seer~y I own or occupy, <br />(~) I am a registereo builder OR ( ) the authorL~ad representative of a mgistarecl <br /> but{del, <br />(~:~ The work will be performed by a registered builder, <br />( ) Other <br />(~ I agree to build according to the submitted plans and specifications, the laws of <br /> the state of Oregon end the ordinances of Marion County <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Valuation' <br /> <br />Bldg Fee:: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge:: <br />Zoning Surcharge:; <br />State Surcharge;; <br />Plans Check Fee:: <br />Site Evaluation Fee:; <br />Septic Permit Fee;; <br />DEQ Surcharge; <br />Technical Review Fee: <br />Reinspection Fee:: <br />investigation Fee:: <br />City Fee, <br /> <br />TOTAL FEE:: <br />RECEIPT NC):: <br /> <br /> <br />