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Received Sy -- <br /> <br />City.'~ <br />zoning ~/alidation __ <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg, NO, 225 <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> PhOne <br /> Code-A-Phone 4;30 EM, - 8;g0 A,M, <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br /> !_ty Setback Requirements ..... <br /> <br /> I Side <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner <br /> <br />Job Address <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Section:: [ Township <br />Lot Width:: Lot Depth <br /> <br />Contractor Business Name <br /> <br />Range <br /> <br />Acres;: <br /> / <br /> <br />and NO <br /> <br />Phone:: Meihn9 Address <br /> 7q~- 17q2- j/0~'7,,£ /¢/ZL <br /> <br />Site NO <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br />Sp # <br /> <br />J 7one;: Map <br />L=FU <br />Irreg ~. Corner <br /> <br />Phone:: <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Cross Street <br /> <br />Fleet S/C Zone:: <br /> <br />Block <br /> <br />Total ~ Spaces <br /> <br /> "l <br />OR <br /> <br />Type of Permit <br /> <br />Height of Building <br />Mobile Home <br /> <br />Width:: <br /> <br />INew <br /> <br /> Alter, <br /> <br />LJ Addition ~(~ Demo <br />~ Relocation ~ Ocs Chg <br /> ex Main Floor:: <br /> No Stori Sq Ft <br /> <br />Mobile_Length Hor~e # Bedrooms ' <br /> <br />Tach <br />Review [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br /> <br />Oc~p~t <br /> <br />Valuation <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation ¢ <br /> Type of System <br /> Test Holes Ready <br /> <br />Will sail when holes ready Proposed Sedrooms <br />Existing Septic System <br />Existlng,,fank Size <br />~isting Dr&infield Length <br /> <br />Type of Sy. stem <br />Date Tank Pumped:: <br /> <br />Existing Bedrooms:: <br /> <br />( } I have read this application in its entirety and certify that the stated information ~e <br /> true and correct to the best of my knowledge <br />/ .~/ I am performin9 work ena property I own or occupy <br />t / I am a registered builder OR ( ) the authorized representative of a registered <br /> builder <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.; PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Suroh&rge <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee:: <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Inv~stigmion Fee <br />City Fee'~ <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> RES ,~ <br /> COM ~ <br /> <br />I Other:--- <br /> <br /> Water Supply <br /> <br /> <br />