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Job Address <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Section::~,~. .... L Township:: <br /> <br />Range <br /> <br />Lot Width Lot Depth:: Acres:: <br /> <br />Site NO <br /> <br />Property Tax Lot No <br /> <br />Lot:: <br /> /..;7 <br /> <br />Sp '¢ <br /> <br />Cross Street <br /> <br />Fleet SfC Zone <br /> <br />Block <br /> <br />Total #' Spaces <br /> <br />ArchC~ct/Engtneer <br /> <br />· Ph°ne:~/¢'¢-/'/¢ <br /> Phone:; <br /> <br />Address:: <br />Address:; <br /> <br />Type of Permit New <br />~uJ~ll, rtff Alter <br />i" Hai~'~i ~f I~uildir~g <br /> <br />Mobile Home <br />Width <br /> <br />L¢/ Addition:: [7_) D~mo <br />[] Relocation:: ~ Oec Cbg <br /> <br />No Stories::/ , Sq//~=,.~,Ft Main~FIoor;; <br />Mobile Home ,¢ Bedrooms <br />Length::'., <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br />Type of System <br />Test Holes Ready <br />Will call when holes ready~ Proposed Bedrooms:: <br /> <br />Existing Septic System:: <br />Existing Tank Size <br /> <br /> Type of System:: <br /> Date Tank Pumped Existing Bedrooms <br /> <br /> I have re~g this r~pplication in its entirety and certify that the mated information ie <br /> ~ true a, nd correct to the beet of my knowledge <br /> 11 am performing work on 8 property I OWn or occupy <br /> art1 a registered builder OR ( the authobzod representative of a regk~tered <br />( ¢/I builder <br /> rbo work will bo porfot~ed by ~ tog~stored builder <br />(t~Other <br /> ageo ob daccodng o esubm edpan8andspeofoe OhS. helewsof <br /> <br /> the etate of Oregon and the ordin ncaa of M, arion County <br /> <br />SIGNATURE OF APPklCANT --'"~ ~' .... ~.,~]" <br /> <br />[] Tach <br /> <br />[] Review:: LJ <br /> <br /> Sq Pt 2nd Floor <br /> <br />O~e of Building <br /> <br />Sq Ft Garage <br /> <br />RES [~ <br />COM [] <br /> <br />Occupant Load <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,; PLUMBING, MF~CHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br /> <br />Bite Evaluation Fee <br />Septic Permit Fee:: <br />DEQ Surcharge:: <br />Technical Review Fee <br />Remspectian Fee:: <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />