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Reds,veal Sy //~?-* ~ ~-¢~. MABION COUNTY~ BUILDING <br />city -' <br />Zoning Validation:; ~' ~ ~ ~ <br /> Ore,on <br /> 97~01 <br />Date, ~'~'~¢ ~'' ~ J,~:~ [?~39 Phone~8-~147 <br /> Cod~Phone 4::30 RM, - 8:00 A,M, <br /> <br />INSPECTION <br /> <br />Cl!y ~..,e. tback Requirements <br /> Front ~ / Rear ~- / <br /> <br /> Left Right <br /> Side:: 5 ! Side 5 <br /> <br />Property~.~Juner <br /> <br />BUILDII~/I~E HOME [] <br /> <br />Job Address:: <br /> <br />SEPTIC [] PERMIT APPLICATION <br /> Mal~ing Ad,dress ~ <br /> <br /> Cross Street <br /> <br />Sit No:; _0 <br /> <br />Fleet S/C Z.~ne:: <br /> <br />Property Tax Lot No:: <br /> <br />S¢lcij.vJsJon~,.~_/*'O~ '/¢/"- ~'~.~~''~ Lot;: / --7 Block <br />Mobile Home Park:; Sp #:: Total # Spaces <br /> <br /> Map <br /> <br />Section:: <br /> <br />Lot Width <br /> <br />Lot Depth <br /> <br />Range:: <br /> <br />Irreg Lot:: <br /> <br />Contractor Business Name and NO Phone <br />Ar~hi~/Engineer:: Phone <br /> <br />Type of Permit:: T New;: <br /> <br />E~~' Addition [] Demo <br />[] Relocation [] Ccc Chg <br /> <br />Height of Building J NO Stories <br />IV' I <br />Mobile Home Mobile Home <br />Width:: Length:: <br /> <br />Sq Ft Main Floor <br /> <br /># Bedrooms:: <br /> <br />Tach <br />Review:: [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Use of Building I RES ~ <br /> <br />Sq Ft Garage '[~-~'e <br />Occupant Load:: W~e/~ ~.r E;upply <br />Va uaton $ .-.~..,"~,-5~'~ <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Type of System <br /> Test Holes Ready <br /> <br />Will call when holes ready <br /> <br />Exieting Septic System <br />Existing Tank Size <br /> <br />Pro,p. osed Bedrooms:: <br /> <br />..... Existing Dreinfield Length <br />Type of System <br />Date Tank Pumped Existing Bedrooms <br /> <br />[ ] I have read this application In Its entirety and certify that the stated Information ts <br /> true and correct to the best of my knowledge <br /> V~lam performing work on a proper~ I own or eceupy <br /> am a regietered builder OR t~ the authorized representative of a registered <br /> builder <br /> The work will be performed by e registered builde[ <br /> Other .................. <br /> I agree to build according to the submitted plans and specifications: the laws of <br /> the state of oregon and the ordinances of Marlon County <br />SIGNATURE OF APPLICANT ,~ ~~ <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge:: <br /> <br />Zoning Surcharge <br /> <br />State Surcharge <br /> <br />Plans Check Fee <br /> <br />Site Evaluation Fee ..... <br />Septic Permit Fee <br />DEQ Sumharge <br />Technical Review Fee:: <br />Reinspeotion Fee:: <br />investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br /> <br />REOEIPT NO <br /> <br /> <br />