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~oning Validetlon;~.~¢~ , <br /> <br />BUILDING [~ MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO, 225 <br /> 220 High Street NE <br /> <br /> · ~ - ' Code-A-Phone 4:30 FtM. - 8:00 A,M. <br /> SEPTIC [] <br /> <br />PERMIT APPLICATION <br /> <br />Pj:c~er ty Owner: <br /> <br />Job Address; <br /> <br />Mobile Home Park: <br /> <br />_? L <br /> <br />['"bontractor SosJnesa Name and NO.: <br />~ineer~ ~ <br /> <br />Property Tax Lot No,; Fleet ~e: <br /> <br />Lot: Block: <br />Sp, ,#; <br /> <br />Zone: ' - Map: T <br />Irreg~ iL°t: C°rn~j~d <br /> <br />Phone; <br /> <br />Address; <br /> <br />Total ¢' Spaces; <br /> <br />Phone; Address: <br /> <br />Type of Permit: <br /> <br />Height of Building: <br /> /V" <br /> <br />Mobile Home <br />Width: <br /> <br />New; ~/' Addition: [] Demo: [] Tach. ..... <br />Alter: [] Relocation: [] Ccc. Chg,; L~ Review: [] <br /> ' No, Stories:/ Sq. /~Ft' Main Floor: Sq. Ft. 2nd Floor: <br /> <br /> Mobile Home ¢ Bedrooms: Occupancy: <br /> Length: ~.~ <br /> <br />Proposed Septic Installation: <br />Previous Bite Evaluation <br /> <br />Type of System: <br />Test Holes Ready; <br /> <br />Will call when holes read,/: <br /> <br />Existing Septic System: <br />Existing Tank Size; <br /> <br />Proposed Bedrooms; <br /> <br /> Existigg ~rainfield Length: <br /> ...... ~ype of System: <br /> Date Tank_.P~mped; Existing Bedrooms: <br /> <br /> ( ,//~l halo read this application ~n its entirety and certify that the s a ed n o ma on s <br /> " e and correct to the boot of my knowledge, <br /> ( £/T~'"t"o~ porforming work on a property i owf~ ;r occup~ <br /> (~,,-'~ l am a registered builder OR f ) the authorized representetive of a registered <br /> <br />$1, N ATU RE OF APPLiC^NT: ~~,f. M i/~ ~ <br />OTHER PERMITS REQUIRED BY/THIS DEPT..' PLUMBING, MECHANICAL. E[.ECTRICAL <br /> <br />Use of Building; <br /> <br />Other: <br /> <br />Occupant Load: ;upply: <br /> <br />Valuation: <br /> <br />RES <br /> <br />COM [] <br /> <br />Bldg. Fee; $~_. ~¢ f.__~_ ~'*/_ <br />Mobile Home Fee: . <br />Fleet Surcharge: ~.. ~L;~/~_ <br />Zoning Surcharge: <br />State Surcharge: ..... ~,. ~.~_. <br />Plans Chec~ Fee; /~* ~ ~ <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: ..... <br />Reinspection Fee: ........... <br />Investigation Fee: <br /> <br />TOTAL FEE: ~ <br /> <br /> <br />