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' Receive8 'By <br /> <br /> City <br /> Zoning Validation:: ...... <br /> <br />Date <br /> <br />BUILDING [] <br /> <br />Property Owner:: <br /> <br />Job Address;: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bida No, 225 <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phons 4;;30 PM, - 8;;00 A,M <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />Subdivision:: <br /> <br />Mobile Home Park <br /> <br />Phone:: <br /> <br />Site No :: <br /> <br />Property Tax Lot NO <br /> <br />Lot:: <br /> <br />Sp ,1,~ <br /> <br /> Setback Requirements <br /> Rear <br /> <br /> R~ght <br /> Left S de:: <br /> Side <br /> <br />PERMIT APPLICATION <br /> <br />Mailing Address <br /> <br />Cross Street <br /> <br />Fleet S/C Zone <br />Block <br /> <br />Total cf Spaces <br /> <br />Section _ Township <br />Lot Width Lot Depth:: <br /> <br />Range:: <br /> <br />Irreg Lot:: <br /> <br />Map <br /> <br />Corner:: <br /> <br />Contractor Business Name and ~0:: <br /> <br />Architect/Engineer:: <br /> <br />Phone Address:: <br /> <br />Phone <br /> <br />Address <br /> <br />Type of Permit:: <br /> <br />Alter <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width:: <br /> <br />[] Addition:: [] Demo ~ Tach <br /> <br />[] Relocation [~ Ccc Chg, ~ Review <br /> <br />NO Stories:: <br />Mobile~ome <br />Length:: <br /> <br />Sq Ft,, Main Floor:; <br />cf Bedrooms <br /> <br />.... ~ Ft, 2nd Floor <br /> Occupancy <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation <br /> Type of System:: <br /> <br />TeSt Hol~e Be_edy:: <br />Will call when holes ready:: Proposed Bedrooms:: <br />Exietin9 Septic System:: <br />Existing Tank Size <br />Existing Drainfield Length:: <br />__T)(_p_e. ~f SY,etem <br />Date Tank Pumped .... E. xiating Bedrooms <br /> <br />SIGNATURE OF APPLICANT <br /> <br />OTHER PERMITS REQUIRED SY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br /> Use of Building:: <br /> <br />[] <br /> <br /> Sq Ft Garage <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />~oning Surcharge <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee:: <br />Septic Permit Fee <br />DEC Surcharge:: <br />Technical Review Fee <br /> <br />Investigation Fee <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br /> RES F! <br /> <br /> COM E3 <br /> <br />Qther <br /> <br />Water Supply <br /> <br /> <br />