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Reselve.d i:: iJ L, ,M?~I~ION UNTY BUILDING <br />' City ,, ~ / Senator Bldg. ~. ~5 <br /> Zoning Va da~ ~ , ~0 High St~t NE <br /> I ~J [.',,...~uOh COUNTY ~lem, Or~ong~l <br /> q/GJ~% ~,UILDiNG I~SPEOT ON <br /> D~te: <br /> Phone ~47 <br /> <br /> BUiLDiNG ~ MOB;L; HOU~ ~ S;PT~C <br /> <br />INSPECTION <br /> <br />City Setback Requirements: <br /> <br /> ~.%OdRear: <br />Front: <br /> <br />Side: "~ I Side: <br /> <br />PERMIT APPLICATION <br /> <br />"Property Owner; '" Phone: Mailing <br /> <br /> Job Address: Site No-: <br /> Cross Street; <br /> ~ ~ ~,,~ ~ ........ <br /> Mobile Home ~rk: Sp, ¢; To~l ~ Spaces: <br /> Se~ion; Township: Range; Zone: M~: . <br /> <br />Contractor Business Name and No,: <br /> <br />Phone: <br /> <br />Architect/Engineer; Phone: Address: <br /> <br />Type of Permit: <br /> <br />Height of Building; <br /> <br />New: 5;~ Addition: [] Demo: [] Tach. <br />Alter: [] Relecatloo: []' Occ. Chg.: [] Review: [] <br /> <br />No, Stories: <br /> <br />Sq. Ft. Main FICO~: <br /> <br />Mobile Home Mobile Home # Bedrcoms: <br />Width: Length: <br /> <br />Proposed Beptic Installation: <br /> Previous Site Evaluation #: <br /> Type of System; <br /> <br />Sq, Ft. 2nd Floor: <br /> <br />Use of Building; <br /> <br />Sq. Ft. Garage: <br /> <br /> RES [] <br /> COM [] <br /> <br />Other; <br /> <br />Occupancy; Occupant Load: Water Supply; <br /> ¢.% ~T-/ ........ <br /> Valuation: $. <br /> <br /> Test Holes Ready: ~/~ .~ .... <br /> Will cell when holes ready: Proposed Bedmorns: <br /> Existing Septic System: <br /> Exisflr~ Tank Size: <br /> Existi~ Dmintield Length: <br /> Type of System: <br /> Date Tank Pumped: Existing Bedrooms; <br /> <br /> I am por[ormlng w~k ~ a property I own or o(~Jgy, <br /> <br /> Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPt.: PLUMBING, MECHANICAL, ELECTRICAL <br />MO 15-6 <br />Rev~ 12/87 <br /> <br /> Bldg. Fee; <br /> <br /> Mobile Home Fee; <br /> Fleet Sumha~ge: <br /> Zoning Surcharge: <br /> State Surcharge: <br /> <br /> · ~ Plans Check Fee: <br /> I~[~ 1/.,O.o~ "--. <br />,~ ~, i.~O.oo / Site Evaluation Fee: <br /> Septic Permit Fee: <br /> <br /> ~DEQ Surcharge: <br /> Technical Review Fee; <br /> <br /> Reinspestiee Fee: <br /> Investigation Fee: <br /> City Fee: /'~' <br /> TOTAL FEE: ~'~ <br /> RECEIPT NO.: <br /> <br /> <br />