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' ' ,, Receiv[~8 By: . <br /> <br /> city <br /> Zoning Validatlen; ~(~_~ <br /> <br /> Date,. <br /> <br />MARION COUNTY BUILDING INSPECTION City Setback Bequirements; <br /> ~enator Biog. NO. 22S Front; ! I Rear' / <br /> 220 High Streer NE ~ ~) I- / (~ <br /> Salem, Oregor~ 97aol Left ~ ~ R~ <br /> <br />BUILDING [] MOBILE HOME [] <br /> <br />Property Owner: <br /> <br /> /LI'-/.~ ? /}/bees <br /> <br />Phone; <br /> <br />Subdivision: <br /> <br />Mobile Home Park: <br /> <br />SEPTIC ._~. PERMIT APPLICATION <br /> I <br /> ..... Mailing Address: '"-~' ! ~ / "~ .... <br /> <br /> S~WN <br /> o.: Cross Street; <br /> <br /> Property Tax Lot No,; F~eet SIC Zone: <br /> Lot: Block: <br /> Sp. #; Total # Spaces: <br /> <br />Section: <br /> <br />Lot Width: <br /> <br /> Township: Range: <br />.... <br />Lot Depth: Acres', <br /> <br />Irreg. Lot; <br /> <br />Map: <br /> <br />Comer; <br /> <br />Contractor Business Name and No,; Phone; <br /> <br />Address: <br /> <br />Architect/Engineer; Phone; Address: <br /> <br />Type of Permit; <br />Height of Building: <br />Width: <br /> <br />New; ~ Addition; [] Demo: <br />Alter: [] Relocation; [] Ccc. Chg,: <br /> <br /> [] Tach. <br /> <br /> [] Review: [] <br /> <br />No. Stories; Sq, Ft, Main Floor: Sq, Ft. 2nd Floor; <br /> <br />Mobile Home ¢~ Bedrooms: Occupancy; <br />Length; y <br /> <br /> Proposed Septic Installation: <br /> Previous Site Evaluation ,¢: //0 ~-,/ ~ ~3 <br />.... Type of Sy~?n; _¥-¢?~,~,' ~_; <br /> Test Holes Ready: <br /> <br />Will call when I}oles ready: <br />Existing Septic System'. <br />Exlstin¢. Tank Size: <br /> <br />ProP_OSed Bedrooms: <br /> <br /> Existing Drainfleld Length: <br />_~',ype of System; <br /> <br />Date Tank Pumped: <br /> <br />Existinn_,q_ .. Bedrooms'. <br /> <br />Use of Building: <br /> <br />Sq. Ft. Garage; <br />Occupant Load: <br /> <br />Valuation: <br /> <br />RBS ~ <br />COM [] <br /> <br />Other: <br /> <br />Water Supply: <br /> <br /> $ <br /> <br />( ) I have read this appJication in its entirety end certify that the stated information is <br /> <br />( ) I an1 performing work on a property I own or Occupy. <br />( ~ ) I am a registered builder OR ( ) the authorized representative of e registered <br /> <br />( ) The work will be performed by a registered builder. <br />( ) Other_ <br /> <br />OTHER PERMITS REQUIRED ElY THIS DEPI',: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br />Bldg. Fee; $ <br />Mobile Home Fee'. <br />Fleet Surcharge: <br />Zoning Sur~haeCJe; <br />State Surcharge: <br />Plans Check Fee; <br />Site Evaluation Fee; <br />Septic Permit Fee; <br />DEC Surcharge: <br />Technical Review Fee; <br /> <br />Relnspection Fee; <br />investigation Fee; <br /> <br />City Fee; <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO.: <br /> <br /> <br />