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BUILDING ~_~]//MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Sen~or Bldg. No. 225 <br /> ~20 High Street NE <br /> Salem, Oregoa 97301 <br /> <br /> Phone 888-5147 <br /> Code-A-Phone 4:a8 P.M. - 8:00 A.M. <br /> <br />SEPTIC [] <br /> <br />ICily Setback Requirements: <br /> <br /> ~ront~ / Rear:~-- <br /> Lef{ '" / Rfght <br /> Side; ,~ Side: <br /> <br />PERMIT APPLICATION <br /> <br />rty O,~ner; <br /> <br />Site No,: <br /> <br />M,~,n g A(~,dress; <br /> Cross S?.eet; '-.~ <br /> <br />Fleet S/C Zone: <br /> <br />Job Address; <br /> <br />Zon <br /> <br />Propert Tax Lot No.: <br /> <br />Su~a~ivi~oQ:(.~//4~/4¢~..~ ~ Lot: / Block: k~ <br />Mobile Home Pork; Sp, ,¢: Total # Spaces'. ....... <br /> <br /> Map: <br /> <br />Lot Width: <br /> <br />Irreg, Lot: <br /> <br />Phone; Address; <br /> <br />/~pe of Permit: Ne~; <br /> <br />Mobile Home <br />Width: <br /> <br />~'-~ff:E''''~- Addition; [] Demo: [] Tach. <br /> <br />[] Relocation: [] Oeo. Chg,; [] Review: [] <br /> <br />No, Stories: <br /> / <br /> <br />Mobile Home <br />Length; <br /> <br />Sq, Ft. Main Floor: Sq, Fl. 2nd Floor'. <br /># Sedrooms: Oceupancy; <br /> <br /> Use of Building: I RES ~ ~ <br /> <br />~'%Oad; Wot Su plo: ..... <br /> <br /> Valuation: $ /~, O O <br /> <br /> Proposed Septic Installation: <br /> Previous Site Evaluation #: <br />___T)~,p.e Of System: <br /> Test Holes Ready; <br /> Will call when holes ready; <br /> <br />Existing Septic System: <br />Existing Tank Size; <br />Ex_i~!ing Drainfield Long_th: <br />Type of S~stem; <br /> <br />.?'9posed Bedrooms: <br /> <br />Date Tank Pumped: <br /> <br />Existtn_9, Bedrooms: <br /> <br /> ) Other ....... / <br /> ) I agree to build aoOOrdirlg to the submitted pl~/a~s ar)~'¢/c~ns, t he laws of <br /> the state of Oregon and the ordinan Marion ty <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAl <br /> <br />Bldg. Fee; <br /> <br />Mobile Home Fee: <br /> <br />Fleet Surcharge: .... <br /> <br />Zoning Surcharge: <br /> <br />State Surcharge: .... <br /> <br />Plans Check Fee: ...... ~. <br /> <br />Site Evaluation Fee; <br /> <br />~ptic Permit Fee; <br /> <br />BE~urcharge; <br />Tech'~icaf Review Fee; <br /> <br />Reinspection Fee: <br /> <br />Investigation Fee: <br /> <br />City Fee; <br /> <br /> <br />