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Zoning Vslidatiom]L. _.]_2J~ .~;~'J~ .. ,,~ ~:~ ~ (::J~.)Q 220 High SI~I NE -' <br />Date: .~~ , . , ' U' ........ sat~, Oregon 973~ ~Left __ ,Right <br /> <br /> BUIL~~E HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Job Addres;F ~/!~" -,, <br /> <br />Subdivision; ~~ <br />Mobile Home Park: <br /> <br /> ~ctio~ I To~naNp~ R~nge'. <br /> R:¢¢ I . I0 <br /> LOt Width: I Lot Depth: <br /> <br />rOntractor Business Name and No,; <br /> <br />Type of Permit: New: <br />j~,~'t~OD ? Alter: <br />Height of Building; ,, <br />Mbbile Home <br />Width: <br /> <br />Addition; [] <br /> <br />[] Relocation; <br /> <br />Phone: Mailing Addre,~ <br />Site NO.: <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation ,¢; <br /> <br />Type ~ System: <br /> <br />Property Tsx Lot NO,; <br /> <br />Test Holes Ready: <br />Will call when holes ready: <br /> <br />Existing Septic System: <br /> Existing Tank Size; <br /> Existing Draint{eid Length: <br /> Type o! System: <br /> Date Tank Pumped: <br /> <br />Cross Street; <br /> <br />Fleet S/C Zone; <br />Block; <br /> <br />Total # Spaces: <br /> <br />Demo: ~ Tach. <br />Ccc. Chg.: [] Review: [] <br /> <br />No, Stories; Sq. Ft. Main Floor: <br />/ <br />Mobile Home / I 4- Bedr0o~s; <br /> <br />Propoeed Bedrooms; <br /> <br />Existing. Bedrooms: <br /> <br /> I have road this application in ils entirety and certify that the stated information is <br /> true and correct to the best ct my knowledge. <br /> [ am performing work on a property I own or occupy. <br /> I em a registered builder OR ( ) the authorized representative of e registered <br /> <br /> the state of Oregon and~ 70~~/ <br />$1GNATUR~ OF APPLICANT: ~.~"~.-~ /' ~ . . <br />OTHER PERMITS REQUIRED aY THIS DEPT, f PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />So,~nd_~loon <br />Occupancy: <br /> <br />Use of ~¥ildJng; ' J RES <br /> <br />Sq. Ft~iar~e'. ~ Other; <br />O~ueant ~ad; W~y~----~ <br /> <br />Mobile Home Fear ~ <br /> <br />Fleet Surcharge: <br />Zoning SurCharge: ~ '~--.~ <br />State Surcharge; ...... ~- <br />Plans Check Fee: -~;~ .-~.' ~-'~--. <br />Site Evaluation Fee: <br />Septic Permit Fee'. <br />DEC Surcharge: ~ <br />Technical Review Fee: ~ <br />Reinspection Fee: <br />Investigation Fee; <br /> <br />RECEIPT NO.: <br /> <br /> <br />