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FOR OFFICE USE ONLY <br /> <br />Received By: <br /> <br />MARION COUNTY BUILDING INSPECI1ON <br />220 High Sheet NE <br /> Salem, OR 97301 <br /> <br /> 8:0o a.m, - 4:00 p,m, Phofle ,588~147 <br /> Code~A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br /> FOR OFFICE USE ONLY <br /> <br />City Setback Requirements: <br /> <br /> MANUFACTURED STRUCTURE & SEPTIC PERMIT APPLICATION <br /> <br />Singl~Family Dwelling [ ] Office [ ] Classroom [ ] Storage <br />RES [ ] C OM [ ]Ncw [ ] Storage [ ]Occ. Cttg. [~R~placemeat [ ]TeclmkalReview <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Location of Installation <br /> <br />2. installation <br /> <br />Pumpee Form Auached ~ <br /> <br />I have ~ad ~ application hl its ~mfimty Md ce~y that the statexl ia/eemmi~ is tree mad <br />correm to [h~ best of my knowlrxlg~, <br />I ~n l~fform/ng work ca a propefo~ I own or occupy, <br />Iarnarci/stel~dlanlder Of( [ ]th~author/zexiropfeiealialiveofareglst~redbtfild.r, <br />'Fne work will bo l~donned by a mg/stea'ed buil&r. <br />Other <br />t agree to <br /> <br />4. Fee Schedule <br /> <br /> Ba~e F** __$89)'i__ <br />~ch Mfg.'d Hccne or Mo~Iul~t Unh <br /> <br />Wa~w~ F~ 25,~ <br /> <br /> (l) T~ ~A~e ~e~ $ <br /> ~) 5% Sam ~, (,~ x Al) <br /> O) ~ s~e 605 x AO <br /> Subm~ $ ~ <br /> <br />C, Mfg,'d Smiemm Storage Fee <br /> <br />E, New ~0 hs~fi~ Pe~ ~e <br />F, Au~ofi~ N~ P~ <br />O. ~r ~t F~ <br />H. ~ T~ R~ew Fee <br /> <br /> ~ ~.~ ~r hint ¢ h~ m~,) ~ <br /> Oty F~ <br /> <br />TOTAL AMOUNT DUE $ -- <br /> <br />NO. <br /> <br /> <br />