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City . ,.~.E,¢.~ <br />ZGnmg Validabon <br /> <br /> BUILDING [] <br /> ,,, <br />B rty er ¢ <br /> <br />Job Address <br /> <br />Subdi~ion <br /> <br />Mobile Home Park <br /> <br />Section ~ Township...~ -'~-- <br />Lot W~dth : Lot De th <br />'_M:_ !' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senetor Bldg. No,, 225 <br /> 220 High Street NE <br /> Salem, Oregon S7301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4::30 P,M, - 8;;00 A.M, <br /> <br /> MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Front ~.~_~. Rear ,~' ~ <br />Side ,~7 ' J Side ,--__~ [ <br /> <br />Phone Moiling Address <br /> <br />-Sit~ No <br /> <br />Property Tax Lot NO <br />Lot ~// <br />Sp # <br /> <br />Fleet S/C Zone <br /> <br />Block:: <br /> <br />Total # Spaces <br /> <br />Zone Map <br />Irreg Lot Corner <br /> <br />Range <br /> <br />Acres <br /> <br />Center Busings Name and No:: <br /> <br />' Phone <br /> <br />/ <br /> Phon~e. <br /> <br />Type of Permit New ~ Addition [~ <br />'~/~, -~ ? Alter [] Relocation:: bJ <br /> <br /> Height of Building NO Stories <br /> /-/' / <br /> Mobile Home Mobile Home <br /> Width Length <br /> <br />Demo [] Tech <br />Ocs Chg [] Review <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br /> <br />Type of SZ~!~m <br />Test Holes Ready <br /> <br />Will call when holes ready <br />Existing Septic System <br />Existing _T~¢k Size:: <br />Existing Drainfield L_e_ngth:: <br />Type of System <br /> <br />Date Tank Pumped <br /> <br />Proposed Bedrooms <br /> <br />Existing Bedrooms <br /> <br />Sq Ft Ma~n Floor Sq Ft 2nd Floor <br /> <br />Other .... :22~ <br /> <br />Use of Building RES [~ <br /> <br />Sq Ft ~arage Other <br />Occupant Load <br /> <br /> Mobile Home Fee <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 /> Teehmoal Review Fee <br /> Reinspection Fee:: ....... <br /> Investigation Foe <br /> <br /> City Fee <br /> <br /> RECEIPT "0 <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC la-6 <br />Rev 12,87 <br /> <br /> <br />