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City <br />Zoning Validation <br /> <br />Date:: /{~ <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg, NO,, 225 <br />220 High Street NE <br /> Salem, Oregon1 973~1 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 P,M. - g:00 AM, <br /> <br /> MOBILE HOME [~ SEPTIC [] <br /> <br /> City Setback Req,~ir?j~~ <br /> <br />L~X~ · I~ <br /> <br />Side' ~ Side <br />/ ~"' <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner:; <br /> <br />Job Address ~ <br /> <br />Subdivision <br /> <br />Mobile Home Park:: <br />Section:; ¥c~vnship ' <br /> <br />Phone:: <br /> <br />Site No :; <br /> <br />Property Tax Lot No,:; <br /> <br />Lot:: <br /> <br />Range { Zone <br />Acres Irreg,, Lot <br /> <br />L~Mai[ing Address <br /> Cross Street:: <br /> <br /> Fleet S/C Zone <br /> <br /> Block <br /> <br /> Total # Spaces:: <br /> ~// <br /> <br />Map <br /> <br />'~o~ <br /> <br />fCoRtractor Business Name and NO,,;: <br />( ....... <br />Archite~ngineer ~ Phone;: <br /> <br />Address <br /> <br />_Type .ef RerrK~t.~..~ J~ New <br /> <br />Addition [] Demo [] Tach <br />Relocation [] Ccc Chg:: [] Review [] <br /> <br />Sq,, Fl, Main Floor <br /> <br />Sq Ft, 2nd Floor:; <br /> <br />Occupancy <br /> <br />Height of Building NO Stories:: <br /> <br />Mobile Home Mobile Home <br />Width:: ~ 6' ~' 'angtb;:h'~'" <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation #:: <br />.Type of System;: <br /> <br />Test Holes R~a_d~y, <br />Will call when holes rea_dy <br /> <br />Proposed Bedrooms;: <br /> <br />Exlstln¢ Bedrooms:: <br /> <br />Existing Septic System <br />Existing_ Tank, Size <br /> Existing Drainfield Length <br /> Type of S.~,~t~m <br /> Date Tank Pumped <br /> <br />Use of Building RES <br />.~'~/e ~,~,/~/ COM <br /> <br />Sq, Ft Garage:: <br /> <br />Occupant Load:: <br /> <br />~ I have read this application if1 its entirety and certify that the stated information is <br /> true and correct to the beat of my knowledge <br /> <br /> builder <br />t ) The work will be performed by a registered builder <br />( <br />( } I agree to bull~ according to the submltled plans a~d specifications, the laws of <br /> <br /> -- _ · <br />OTHER PERMITS REQUIRED BY THE!~ DEPT.: PLUMBING, MECFIANICAL, ELECTRICAL <br /> <br />,, Othe~ <br /> Water, S pply <br /> <br />Valuation:: <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee:: <br />Fleet Sumharge <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 />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO:: <br /> <br /> <br />