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Date __:,..~.~/_~-'~/~ ~ <br /> BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. 225 <br /> <br /> MOBILE HOME [] SEPTIC~ <br /> <br />FrOity Betba~k Requiremen_ts: <br />oat; ~ Rear; <br />pLait .~ Right <br />j S de: <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner: <br /> <br />Job Address; ~' <br /> <br />Subdivision~ lot ~'.'~ ~--~ L ~_ ~) ~- <br />Mobile Home Perk; <br /> <br />b~ene; Mailing Address: <br /> Bite Ne,; <br /> <br />Property Tax Lot No.; <br /> <br />Lot: <br /> <br />Sp. #: <br /> <br />Cross Street; <br /> <br />Fleet S/C Zone: <br /> <br />Total ~ Spaces; <br /> <br />Section; Township: <br /> <br />Lot Width; Lot Depth: <br /> <br />Zone; Map: <br />Irreg, Lot; Corner: <br /> <br />Contractor Business Name and No,: <br />Architect/Engineer; <br /> <br />Phone; <br /> <br />Phone; <br /> <br />Address; <br /> <br />Address: <br /> <br />Type of Permit: New;' <br />Height of Building: <br /> <br />Mobile Home <br />Width: <br /> <br />Addition; [] Demo: <br />Relocation; [] Ccc. Chg,: <br /> <br />Tach. <br /> <br />Review; <br /> <br />No, Stories: <br /> <br />MobiLe Hems <br />Length: <br /> <br />Sq, FI, Main Floor'. <br /> <br />Bedrooms: <br /> <br />Sq, Ft. 2nd FLoor: <br /> <br />Proposed Septic installation; <br /> Previous Site Evaluation ~; , L J J :~' --.-.-.-.-.-.-.-.-.~ <br /> Type of System: ~t.-~4~A,,<t~c~L. ..... <br /> Test Holes Ready; <br /> <br /> Existing Or,infield _?..n_gth: <br /> Type of.System: <br /> Date Tank Pumped: Existing Bedrooms: <br /> <br />~,~ t have read this application is ifA, entirety and certify thai the stated information is true and correct to the best Of ~y knowledge. <br /> I ~m performing work on a property I own or ocCupy, <br /> <br /> Other <br /> <br /> the state of Oregon ~nd the ord~orJs of Marion County(~___,,.~. <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Buildlng; <br /> <br />Sq. Ft. Garage: Other; <br /> <br />Occupant Load: Water Supply: <br /> Valuation: $. <br /> <br />RES [] <br /> <br />CUM [] <br /> <br />Bldg. Fee: $. <br />Mobile Home Fee: <br />Fleet Surcharge: ........... <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Cheek Fee; <br />Site Evaluation Fee', <br />Septic Permit Fee: ~'~.,~0 <br />DEQ Surcharge: '5'% ~ o <br />Technical Rev{aw Fee: <br />Reinspectioa Fee: <br />Investigation Fee; <br />City Fee: <br />TOTAL FEE; J <br />RI~CEIPT NO.: <br /> <br /> <br />