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Received By _, <br /> <br />City <br />Zoning Validation <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg, NO. 225 <br /> 220 High Street NE <br /> Salem= Oregon 97301 <br /> <br /> Pno,e 588-5147 <br /> Code-A.Paone 4::30 EM, - 8:00 A.M. <br /> <br /> y Setback Requirements:: <br /> <br />rent Rear:: <br />'t i.~f~- Right <br />e Side <br /> <br /> BUILDING [] <br />Property Owner ~ <br /> / <br />Job Address ~ . <br /> <br />MOBILE HOME [] SEPTICS,_, PERMIT APPLICATION <br /> Phone ,~t,¢~'....4~'~"'"~'I Mailing Address::/(' " <br /> <br /> Site No:: Cross Street <br /> <br />Property Tax Lot No /~ <br /> <br />Lot/,~ <br /> <br />Fleet SIC Zone <br /> <br />Mobile Home Park Bp ¢e Total ¢· Spaces <br /> <br />Lot Width/ Lot Depth:: k' Acres~ <br /> <br />Zone ~ ~_~ Map qCj(~ <br />Irreg, Lot~ Corner ,~ <br /> <br />Contractor Business Name end NO Phone Address <br />Architect/Engineer Phone Address:: <br /> <br />Type of Permit' New [] Addition:: [] Demo [] Tach, RES 6~ <br /> <br /> Alter ~ Relocation [] Ccc Chg [] Review COM [] <br /> <br />Height of Building No Stories <br /> <br />Mobile Home <br />Width <br /> <br />Sq Ft Main Floor <br />~ Bedmoms,2~ <br /> <br />Mobile Home <br />Length:: <br /> <br />Sq Pt 2nd Floor <br />Occupancy:: <br /> <br />Proposed Septic installation <br />Previous Bite Evaluation ~¢ <br /> <br />Test HOleS Ready,,/~ ,,/0-'~'~0 ,.""" <br />E~,,S~g Tank Size:: <br /> <br />Existing Drainfield Length <br /> <br />Type of System <br /> <br />Date Tank Pumped:: <br /> <br />Existing Bedrooms <br /> <br /> builder <br /> Tho wets will be performed by a registered builder <br /> <br /> I agree to build according to the submitted plans and speoifioat~ons= the laws of <br /> <br />OTHER PERMITS REQUIRED DY THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br /> Use of Building:: <br /> <br />[] <br /> <br /> Sq Ft Garage:: <br /> Occupant Load <br /> <br />Other <br /> <br />Water Supply <br /> <br />Valse, lion :: $ <br /> <br />bldg Fee $ <br />Mobile Home Pea <br />Fleet Surcharge:: <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 />RECEIPT NO <br /> <br /> <br />