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Reserved By <br /> <br />C~ty <br />Zoning Validation:: <br /> <br />MARION COUNTY BUILDING INSPECTION ~_Setback Req,uiremen!s __ <br />E~ef~ator IBJdg, No, 225 <br /> 220 High $trec{ NE Front Rear <br /> Salem, Oregon 97301 --~ ~ <br /> Phone 588-5147 ~ Side <br /> Code-A-Phone 4:30 E,M, - 8:00 AM. <br /> <br /> MOBILE HOME ~ SEPTIC APPLICATION <br /> <br />BUILDING <br /> <br /> Subdivision <br /> <br />-Mobile-Home Park <br /> <br />Phone ....... Moiling Address <br /> Site No Cross SJrea! <br /> <br />Property Tax Lot No <br /> <br />Lot:: G <br /> <br />Map <br /> <br />Corner:: <br /> <br />Fleet S/C Zone <br /> <br />B~ook ~_~ <br /> <br />TotaI# Spaces <br /> <br />Section ~¢~2C4 -LOt D Acres Irreg Lot:: <br />LO1 Width / ~t~ <br /> <br />Contractor Business Name and~ NO ~/~. ~ .2. -/¢! ~. <br /> <br />Phone <br /> <br />Phone <br /> <br />Add~ese' <br />Address e7~-~Zf_~ J <br /> <br /> .type of Permit F~ew---' Fq Addition [~ Demo:: <br />?~,e¢~' rc_ ¢,e&,h-J Alter rq Relocation El Ccc Oho <br /> <br /> Height of Building NO Stories Sq Ft Main Floor <br /> <br /> Mobile Home Mobile Rome # Bedrooms:: <br /> Width ~ Length ~ ¢._) / <br /> <br />[] Tach <br /> <br />I~ Review r~ <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Occupancy:: / <br /> <br />Use of Building ¢ ~ ~ RES ,[~ <br /> eOM fq <br /> <br />Sq ~t Garage / Other <br /> t <br />Occupant Load Water Suppl <br /> <br />Proposed Sepfie Inslallation <br />Previous Site Evaluation # <br /> <br />Type of System <br /> <br /> Test Holes Read. y:; <br />Will Call when holes read3/- <br />Existing Sepfie System <br />Existing Tank Size <br />Existing Drainfield Length <br />Typ~ of System <br /> Date Tank Pu?ped <br /> <br />Proposed Bedrooms ~_ <br />Existing Bedrooms:: <br /> <br />agree to build according to tho Submitted plans and specifications: the laws of <br /> .... <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,; PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15,6 <br />Rev 12,87 <br /> <br />Bldg Fee <br /> <br />Mobile Rome Fee <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 />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br />· DO <br /> <br /> <br />