Laserfiche WebLink
Senator Bidg,, NO,, 225 ff ?/~ ~ .... I J <br />CIt'y v ~- ..; /~ ~ ~Kon~r?'~, Pear:: <br /> Salem~ Oregon 97301 r' , ' ~ ~t <br /> Code-A-Phone 4:30 PM. ~t~ ~]UpL t~. ~ ' <br /> <br /> BUILDING ~ MOB LE HOME ~ SEPTIC ~'~E~i~,~pLICATIO" <br /> '~perty Owner::_ ' ~ ~ Phone Ma~ng Addre~"V <br /> <br />Job Address - <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Site No <br /> <br />Lot <br /> <br />Sp #: <br /> <br />Property Tax Lot N~ <br /> <br />Zone Map <br />Irreg,]., ~ Lot C o r,~,~. <br /> <br />C~__~./,~s Street:: / <br />Eleet $~C Zone: <br /> <br />Block <br /> <br />Total # Spaces:: <br /> <br />Type of Permit:: <br /> <br />New ~ <br /> <br />Alter <br /> <br />Add~ <br /> <br />AdditiOn [] Demo:: [] Tach <br />Relocation:: [] Ccc Chg ~ Review <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy:: <br /> <br />,;-'?zwa ' <br /> <br />Height of Building:: No Stories <br /> / .... <br />Mobile Home Mobile Horce <br />Width Length <br /> <br />Sq, Ft Main Floor:: <br /> <br />cf Bedrooms <br /> <br />U~e of Building, ~ <br /> <br />Sq Ft Garage:: Other <br />Occupant Load Water Supply <br />Valuation $~WO, <br /> <br /> Proposed Septic Installation <br /> Previous Site Evaluation cf <br /> <br />...... T~ype, of System;: <br /> Test Holes Ready <br /> <br /> Will call when holes ready Proposed Bedrooms;: <br />Existing Septic System <br /> E X_i st i n~g_T_a n~k _S i_z_e- <br /> Existing Drainfiold Length <br /> <br /> Type of System <br /> <br /> Date Tank Pumped ....... Existing Bedrooms:: <br /> ~1 have read this application ~n its entirety and certify that the stated information is <br /> <br /> builder <br /> The work will be performed by a registered builder <br /> Other <br /> <br />OTHER PERMITS REQUIRED EPT,; PLUMBING, MECHANICAL, ELECTRICAL <br />MO t5-6 ~ <br />ROy 12t87 ,~ <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee:: <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br /> <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge:: <br />Technical Review Fee:: <br />Reinspeetion Fee <br />Investigation Fee:: <br />City Fee;: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />