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Bate <br /> <br />BUILDING [~ MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bidg,, NO,, 225 <br />220 Hlgll Street NE <br /> Salem= Oregon 97301 <br /> <br /> Pflone 588-5147 <br /> Coee-A-Phone 4::30 RM, - 8:00 A,M <br /> <br /> SEPTIC [] <br /> <br /> City Setbac~k Re~ <br /> Front:: L~O [ Rose ._~~ <br /> Left .~.,,..~ [ R~ght <br /> i <br />PERMIT APPLICATION <br /> <br />Prop~e~ty Owher . Phone:: Mailiog Add[ess:: <br />Site NO <br /> <br />Job Address:: <br /> <br />Property Tax Lot Ne <br /> <br />Cross Street <br /> <br />Fleet S/O Zone:: <br /> <br />Subdiv~ion, Lot ¢ Block / L~ <br />M~de ~eme ~rk Sp # ~tel # Space~ <br />Map: <br /> <br />Lot Width Lot Depth;: <br /> <br />Range:: <br /> <br />Contractor Busines~ Name end NC, ~ <br /> <br />Phone' <br /> <br />Phone:; <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of P?rmit ] New:: -. Addition [] Demo I~ Tach <br /> <br />~l.,'~.~3) Alter Relocation I~ Ccc Chg:: ~ Review <br /> Sq Ft 2nd Floor <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width;: <br /> <br />NO Stories <br /> / <br /> <br />Mobile Home <br />Length:: <br /> <br />Sq Ft Main Floor:: <br /> <br />Bedrooms <br /> <br />Occupancy:: <br /> <br />Use of Building RES ~ <br /> <br />Sq Ft Garage' Other <br />Occupant Load w~S_upply <br /> Valuation $(/~_~,,~4~,,,,. ~ <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Type of System, <br /> Test Holes Beady <br /> Wtll Call when holes ready <br /> <br />Existing Septic System <br />Existin~ T~tnk Size <br /> <br />P~.r. oposed Bedrooms:: <br /> <br />Existi__n~g Drainfield Length~ <br />Typ,? of System <br /> <br />Date Tank Pumped <br /> <br />Existing Bedrooms:: <br /> <br /> Tb-~;d~v~)¢k will be porter nled by e registered bl.jJlder <br /> Other <br />~'~/I agree to builo a~rding to the susmitto¢, and speclflcat~o~jaw~ ot <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.; PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~$-6 <br />Rev 12~87 <br /> <br />@ldg Fee:: $_ <br />Mobile Home Fee:: <br />Fleet Surcharge <br /> <br />Zoning Surcharge:: <br />State Surcharge ~'~' <br /> <br />Plans Check Fee <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Reinspectien Fee:: <br /> <br />Investigation Fee <br /> <br />RECEIPT NO 7////7 <br /> <br /> <br />