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Received By <br />City ' - <br />Zoning Validation <br /> <br /> ~:~,¢) ,-'= ~t'~ , ,~,~.~ . <br />MARION COUNTY BUILD ,1~'G ~tNSPECTI~N/ ~ ,r~ci~etback ~?.9.u.,relents_ <br /> 220 HIgh Str~t NE ~ 1 ~Front~ /~ I~ /~¢ <br /> <br />Property Owner <br /> <br />,/ob Address/ <br /> <br /> Code-A-Phone43S P.M --800~-~' ~-;~ '~ ,~] ~ <br />BU LD NG [~,"~MOB LE HOME [] SEPTIC ' PERI~li~LICATION <br /> '~T Phone Mail~g Ad, ross:: <br /> / <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Section:; ] Township:: <br />LOt Width / Lot Depth <br /> <br />Range <br /> <br />Property Tax Lot No <br /> <br />I'ot <br /> <br />Sp ~:: <br /> <br />Cross Stree <br /> I/ CPiP <br /> <br />Fleet SIC Zone <br /> <br />Total # Spaces <br /> ? <br /> <br />Irr~/~ot Corner:: <br /> <br />At~,,?/it eat } E ngirteer <br /> <br />~¢.?A_a of Permit New ~ Addition <br /> <br /> * ¢- · Alter LJ Relocation <br /> <br />Height et B~lding <br /> <br />No Stories <br /> / <br /> <br />[~ Demo r- <br />[] Ccc Chg:: [] <br /> <br />Tach <br />Review:: [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Sq Ft Main Floor <br /> <br />Use of Building RES ~ <br /> <br />Sq Ft Garage Other <br /> <br />Occupant Load Wat~ly <br />V.,u bo ¢1 00 <br /> <br />Mobile Home Mobile Home ¢ Bedrooms Occupancy <br />Width:: Length <br /> <br />Proposed Septic installation:: <br />Previous Site Evaluation # <br /> <br />T~/,.~,.e., of.System, <br />Test Holes Ready <br /> <br />Will call when holes reedy <br />Existing Septic System <br />Existing Tank Sise_ <br />Existing Drainfield Length <br /> <br />Type of S~e_tem:: <br />Date Tank Pumped <br /> <br />Proposed Bedrooms <br /> <br />Existing Bedrooms <br /> <br /> \ <br />OTHER PERMITS REQUIRED BY THIS DEFT.: PLUMBING, MECHANICAL, EL~.CTRICAL ~ '~ <br /> <br />Bldg Fee $ /'Z, <br />Mobile Home Fee <br />Fleet Suroharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee .[/, <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee:: <br /> <br />City Fee <br />TOTAL FEE:: --~.-"~ :: <br />RECE,PT '7 <br /> <br /> <br />