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Received By ~.~// ¢-/~/--'~¢~Zz;- MARION COUNTY BUILDING INSPECTION <br /> City . ,4.Pl <br /> Senator B~dg, No,, 225 <br /> ~oning Validation ~C~ 220 High Street NE <br /> ~ ~., Salem, Oregon 97301 <br /> <br />~ ~ Code-A-Phone 4~30 P,M,, ~ 8;;00 A,,M,, <br /> BUILDING~ MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> P~erty ~er '~ ........ ~ Phone:; ~ ~ailing Address ~. , <br /> <br />S u b.~,ision <br /> <br />Mobile Homa Park <br /> <br />Property Ta,x Lot No <br />':-/~mzh; , l ¢: <br />Lot <br /> /¥ <br />Sp # <br /> <br />~etback Re~uiremenl_s. <br /> ,~ · Rear c~~- / <br />· -._-,' <br />['~s~t~- ,_~ Side:: ,~_~" <br /> <br />Cross Street:: <br /> <br />Fleet S/C Zone:: <br /> <br />Block <br /> <br />Total // Spaces <br /> <br />Lot Widthi" <br /> <br />Township <br /> <br />Lot De th <br /> <br />Range <br /> <br />Map <br /> <br />Corner._ <br /> <br />_C,~raotor~usiness Name and No <br /> <br />Phone <br /> <br />Arc ' eot,' n ineer <br /> <br />Address i <br /> <br />Address - ,, <br /> <br /> Type of Permit I New ~ Addition [] Demo <br />~/~/~/~/_,j,~Alter [] Relocat,on:: [] Ccc Chg <br />Height of Building <br />.IM / <br /> <br />Mobile Home <br />Width <br /> <br />No Stories <br /> / <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main Floor <br /> <br /># Bedrooms <br /> <br />[] Tech Uso of Building RES <br /> <br /> . <br /> _Occupancy Occupant Load <br /> <br />Valuation <br /> <br />Proposed Sepkc Installation <br />Prewous Site Evaluation # <br /> Typo of System <br /> <br />Test Holes Read~_:: <br />Will Call when holes ready <br /> <br />Proposed Bedrooms <br /> <br />Existing S~ptic System <br />Existing Tank Size <br /> <br />Existing Oreinfield Length <br /> <br />Type of System <br />Date Tank Pumped <br /> <br />Existing Bedrooms <br /> <br />113 av¢~ read [tlF~ ~pplic~tion ~n ~ts entirety and cerhfy that the stated information is <br />trtJe 8nd correct to the best of my kflowlodgo <br /> <br />OTHER PERMITS REQUIRED BY THIS DI=PT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15.6 <br />Re~ 12,87 <br /> <br />Mobile Rome Fee <br />Fleet Surcharge -- <br /> <br />Zoning Surcharge <br />State Surcharge //(~' ~''* <br />Plans Check Fee t/lCd, 0:/ <br /> <br />Site Evaluation Faa <br /> <br />DEQ Surcharge <br /> <br />TOTA~ ~EE ~,2 '-' <br />RECEIPT NO <br /> <br /> <br />