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Received ~y <br /> <br />City, ~ <br />Zoning Yalidetior~ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> .~eneJor Bleg. No. 225 <br /> 220 Hlge Street NE <br /> Salem. Oregon 97301 <br /> <br /> Phone $88-$147 <br /> Code-A-PhOne 4::$0 P.M. - 8;:00 A.M, <br /> <br />BUILDING [] MOBILE HOME [] SEPTIC [] <br /> <br /> City Setback Require~.m.entS <br /> <br /> Front Rear <br /> <br /> Left - R~ght <br /> Side I Side <br /> <br />PERMIT APPLICATION <br /> <br />S~bdivision <br /> <br />Mobile Hon"~e Park;: <br /> <br />-Lot Width:: <br /> <br />Township <br /> <br />Lot Depth <br /> <br /> Mailing Address <br /> <br />Site No:: <br /> 7o <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br /> Sp # <br /> <br />Range ~ Zone:: " <br /> Irreg "Corner <br /> <br />Cross ~treet <br /> <br />F eat SIC Zone <br /> <br />Total # Spaces <br /> <br />tContractor Business ~Jeme and <br /> <br /> _ g <br /> <br />Phone <br /> <br />Phone:: <br /> <br />'Type of Permit <br /> <br />'~ of Building <br /> <br />Mobile Home <br />Width <br /> <br />New [] Addition [] Demo:: [] Tach <br /> <br />Attar [] Relocation [] Oeo,, Chg [] Review [] <br /> <br />No Stories <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main~ <br /> <br />Address <br /> <br />Proposed Septic installation <br />Previous Site Evaluation # <br /> Type of System <br /> Test Holes Ready <br /> <br /> Will sail when holes reedy <br /> Existing Septic System <br /> Existin9 Tank Size <br />~_Ext~ting Drainfield Length <br />' Typ; of System <br /> <br />Proposed Bedrooms <br /> <br />Date Tank Pumped Existing Bedrooms J <br /> <br />OTRER P~RMITB REQUIRED BY TRiS ~yP'fc~LtJMl~lN~i, MECRANtCAL, ELECTRICAL <br /> <br />Address' <br /> <br />Occupancy:: <br /> <br />Use of Building J R [] <br /> <br />Sq Ft Gara~e~,~ther~~' ~ <br /> <br />Occupant Lo~d Water' Supply <br /> <br />Valuation <br />Bldg Fee $. '-~-~' <br />Mobile Home Fee <br /> <br />Fleet Surcharge <br />Zoning Surcharge ~- ',~-'~ <br />State Surcharge ~ "~--"~ <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Teshnicel Review Fee <br />Reinspection Fee <br /> <br />h~vestig~ibrt Fee <br />City ~e <br /> <br />TOTAL FEE:: <br /> <br />RECEIPT NO:: <br /> <br /> <br />