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Received By; <br /> <br />City <br />Zoning Validation: ........... <br /> <br />Date: _ <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> '~eflator Bldg, No..225 <br /> ~.. 220 High Street NE <br /> Salem, Oi~9on 97301 <br /> Phone 588-5147 <br /> Code-A-Phone 4::30 RM. - 8:00 A.M- <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />Property Owner; Phone: <br />Job Address: <br /> <br />Subdivision; <br /> <br />Mobile Home F~trk: <br /> <br />Site No,: <br /> <br /> / <br />Town?.~ / Range: <br /> <br /> City Setback Requirements; <br /> <br /> Front; Rear: <br /> <br /> Left Right <br /> Side: Side; <br /> <br />PERMIT APPLICATION <br /> <br />Mailing Address: <br /> <br /> Cross <br /> <br />Property Tax Lot No.; <br /> <br />Fleet SIC Zone: <br /> <br />Block; <br /> <br />Total ¢~ Spaces; <br /> <br /> Sp. #: <br /> <br />Zone; <br /> <br /> Corner: <br /> <br />Contractor Business Name and No.; <br /> <br />Phone; Address: <br />Phone; Address: <br /> <br />Type of Permit: New: [] Addition: [] Demo: [] Tach, Use of Building; <br /> Alter: [] Relocation; [~ Ccc. Chg.: [] Review: ~ <br />Height of Building; Sq, Ft, 2nd Floor: Sq. Ft. Garage: <br /> <br />Mobile Home <br />Width; ~.~ <br /> <br />_, NO, Stories; <br /> Mobile Home <br /> Length: y~ <br /> <br />Sq. Ft. Main Floor; <br />~¢ Bedrooms: <br /> <br />Occupancy: <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br /> <br />Type of System; <br />Test Holes Ready: <br /> <br /> Will call when holes ready; Proposed.~edrooms: <br /> Existing Septic Syst~: _~__ // <br />~E,~!stlng Tank Size: /~[,Z(~¢.~ ~ <br />Existing Dralnfield Length: <br /> <br />l~p~ of System: <br />Date Tank Pumped; .~.-?,,,-~.~,,~"~,,,Existlng Bedrooms: ....... <br /> <br /> ) Other ......... <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Occupant Load; <br /> <br /> RES [] <br /> COM [] <br /> <br />Other: <br /> <br /> Valuation: <br /> <br /> Bldg. Fee: <br /> <br />Mobile Home Fee; <br />Fleet Sumharge: <br />Zoning Sumharge: <br />State Surcharge: <br />Plans Check Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee; <br />DEQ Surcharge: <br />Technical Review Fee: <br />R~inspection Fee: <br /> <br />Investigation Fee: <br />~'~y Fee: <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br /> <br />