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C~y <br /> <br />BUILDING [] <br /> <br />MARION COUNTY-BUILDING INSPECTION <br /> Senator Bidg,, NO, 225 <br /> 220 High Street NE <br /> Salem~ Oregon e7301 <br /> Phone 588-5147 <br /> <br /> MOBILE HOME [] SEPTIC [~ <br /> <br /> I City-Sitback Requ,re.~_e__nts <br /> I~.r~itFront R~[~Roar <br /> ISi% IS'de <br /> <br />PERMIT APPLICATION <br /> <br /> .................. Phone <br />Property Owner ~_. ~ <br /> <br />J'~b Address , <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Site No <br /> <br />Section ,~ ~:: <br /> <br />Property Tax Lot No:: <br /> <br />Fleet S¢C Zone <br /> <br />Lot Block <br />Sp # <br /> <br />Rang~ Zone Map <br />Acres Irreg Lot ~ U~72er <br /> <br />Total # Spaces <br /> <br />~¢chiteot/Engineer:: <br /> <br />Phone <br /> <br />Phone:: <br /> <br />Address:: <br /> <br />Address;: <br /> <br /> T~eof Permit INew ['1 Addition [] Demo [] Tach <br /> ~ Alter ,f~ Relocation:: [] Ccc Chg [] Review <br /> <br />Height of Building NO SIories Sq Ft Main Floor:: Sq Ft 2nd Floor:: <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br /> <br /> RES <br /> COM <br /> <br />Other <br /> <br />Mobile Home Mobile Home ¢ Bedrooms Occupancy:: Occupant Load Water Supply <br />Width Length <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation #:: <br /> <br />. Ty~e Of System:: <br />Test Holes Ready:: <br />Will call when holes ready Proposed Bedrooms <br />Existing Septic System <br />Existing Tank Size <br />Existin(~_Dr~!nfletd Length <br />Type of System:: <br /> <br />Date Tank Pumped:: <br /> <br />Existing Bedrooms <br /> <br />SIGNATURE OF APPLICANT . <br /> <br />OTHER PERMITS REQUIRED BY THIS OEP'r,; PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Valuation $. <br /> <br />Bldg Fee $. <br />Mobile Home Fee:: <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br /> <br />Site Evaluation Fee <br />Septic Permit Fee.r_-[(~UO_O <br />DEQ Surcharge:: <br /> <br />Technical Review Fee <br /> <br />Reinspection Fee <br /> <br />Investigation Fee <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO:: <br /> <br /> <br />